Hyperkalaemia in Heart Failure—Pathophysiology, Implications and Therapeutic Perspectives
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Purpose of Review
Hyperkalaemia is a frequent and sometimes life-threatening condition that may be associated with arrhythmia and cardiac dysfunction. Evaluating the prevalence of hyperkalaemia in patients with heart failure (HF) and potential treatments of this condition is essential for patients using renin–angiotensin–aldosterone system inhibitors or angiotensin receptor–neprilysin inhibitor and mineralocorticoid receptor antagonists, which represent the cornerstone and highly proven life-saving therapy.
Novel findings from the past few years include data regarding the epidemiology, pathomechanisms, implications and novel therapeutic approaches to counteract hyperkalaemia in patients with HF. Whilst older potassium-binding agents are associated with serious adverse events, novel potassium-binding drugs are effective in lowering potassium levels and are generally well tolerated.
Hyperkalaemia represents both a direct risk of cardiovascular complication and an indirect biomarker of the severity of the underlying disease such as neurohormonal activation and renal dysfunction. Novel potassium-binding drugs such as patiromer and sodium zirconium cyclosilicate may help to optimize therapy in HF and achieve guideline-recommended doses.
KeywordsHyperkalaemia Cardiovascular mortality Heart failure Sacubitril/valsartan Renin–angiotensin–aldosterone system ZS-9 Patiromer
This work was supported by the German Research Foundation (DFG) SBF TRR219 projects C09, M02, M03, M05, M06 and S01.
Compliance with Ethical Standards
Conflict of Interest
Redi Llubani, Davor Vukadinović, Christian Werner, Nikolaus Marx and Stephen Zewinger declare no conflicts of interest.
Michael Böhm reports personal fees from Amgen, personal fees from Bayer, personal fees from Servier, personal fees from Medtronic, personal fees from Boehringer Ingelheim, personal fees from Vifor and personal fees from Bristol Myers Squibb, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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