Serum potassium dynamics during acute heart failure hospitalization

Abstract

Background

Available information about prognostic implications of potassium levels alteration in the setting of acute heart failure (AHF) is scarce.

Objectives

We aim to describe the prevalence of dyskalemia (hypo or hyperkalemia), its dynamic changes during AHF-hospitalization, and its long-term clinical impact after hospitalization.

Methods

We analyzed 1779 patients hospitalized with AHF who were included in the REDINSCOR II registry. Patients were classified in three groups, according to potassium levels both on admission and discharge: hypokalemia (potassium < 3.5 mEq/L), normokalemia (potassium = 3.5–5.0 mEq/L and, hyperkalemia (potassium > 5 mEq/L).

Results

The prevalence of hypokalemia and hyperkalemia on admission was 8.2 and 4.6%, respectively, and 6.4 and 2.7% at discharge. Hyperkalemia on admission was associated with higher in-hospital mortality (OR = 2.32 [95% CI: 1.04–5.21] p = 0.045). Among patients with hypokalemia on admission, 79% had normalized potassium levels at discharge. In the case of patients with hyperkalemia on admission, 89% normalized kalemia before discharge. In multivariate Cox regression, dyskalemia was associated with higher 12-month mortality, (HR = 1.48 [95% CI, 1.12–1.96], p = 0.005). Among all patterns of dyskalemia persistent hypokalemia (HR = 3.17 [95% CI: 1.71–5.88]; p < 0.001), and transient hyperkalemia (HR = 1.75 [95% CI: 1.07–2.86]; p = 0.023) were related to reduced 12-month survival.

Conclusions

Potassium levels alterations are frequent and show a dynamic behavior during AHF admission. Hyperkalemia on admission is an independent predictor of higher in-hospital mortality. Furthermore, persistent hypokalemia and transient hyperkalemia on admission are independent predictors of 12-month mortality.

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Abbreviations

ACE:

Angiotensin-converting enzyme

AHF:

Acute heart failure

ARB:

Angiotensin II receptor blocker

HF:

Heart failure

MRA:

Mineralocorticoid receptor antagonist

RAAS:

Renin–angiotensin–aldosterone system

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Funding

This work is funded by the Instituto de Salud Carlos III (Ministry of Economy, Industry, and Competitiveness) and co-funded by the European Regional Development Fund, through the CIBER in cardiovascular diseases (CB16/11/00502).

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Correspondence to Juan F. Delgado.

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Caravaca Perez, P., González-Juanatey, J.R., Nuche, J. et al. Serum potassium dynamics during acute heart failure hospitalization. Clin Res Cardiol (2020). https://doi.org/10.1007/s00392-020-01753-3

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Keywords

  • Dyskalemia
  • Hyperkalemia
  • Hypokalemia
  • Potassium
  • Heart failure