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Treatment of Hyperkalemia in Heart Failure

  • Pathophysiology of Myocardial Failure (Inder Anand and Maria Patarroyo-Aponte, Section Editors)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The aim of this paper is to discuss strategies for prevention and management of hyperkalemia in patients with heart failure, including the role of novel therapies.

Recent Findings

Renin-angiotensin-aldosterone system (RAAS) antagonists, including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) decrease mortality and morbidity in heart failure but increase the risk of hyperkalemia, especially when used in combination. Prevention of hyperkalemia and its associated complications requires careful patient selection, counseling regarding dietary potassium intake, awareness of drug interactions, and regular laboratory surveillance. Recent data suggests that the risk of hyperkalemia may be further moderated through the use of combined angiotensin-neprilysin inhibitors, novel MRAs, and novel potassium binding agents.

Summary

Clinicians should be mindful of the risk of hyperkalemia when prescribing RAAS inhibitors to patients with heart failure. In patients at highest risk, such as those with diabetes, the elderly, and advanced chronic kidney disease, more intensive laboratory surveillance of potassium and creatinine may be required. Novel therapies hold promise for reducing the risk of hyperkalemia and enhancing the tolerability of RAAS antagonists.

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Authors and Affiliations

  1. Cardiovascular Division (ASD) and Department of Medicine (EMD, ASD), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Ersilia M. DeFilippis & Akshay S. Desai

  2. Advanced Heart Disease Section, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Akshay S. Desai

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  1. Ersilia M. DeFilippis
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Correspondence to Akshay S. Desai.

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Ersilia M. DeFilippis declares no conflict of interest.

Akshay S. Desai has received research grants from Novartis and has been a consultant to Relypsa, Novartis, St. Jude Medical, Janssen, Sanofi, AstraZeneca, and Merck.

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This article is part of the Topical Collection on Pathophysiology of Myocardial Failure

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DeFilippis, E.M., Desai, A.S. Treatment of Hyperkalemia in Heart Failure. Curr Heart Fail Rep 14, 266–274 (2017). https://doi.org/10.1007/s11897-017-0341-0

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