Abstract
Significant improvements in the morbidity and mortality associated with chronic heart failure have been gained with the use ACE inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and diuretics. However, the use of these agents is often limited by their propensity to precipitate worsening renal function and hyperkalemia, particularly in patients with chronic kidney disease. Several pharmacologic agents have been developed in recent years that utilize the gastrointestinal tract as an alternate route for drug absorption, electrolyte exchange, and drug and electrolyte elimination. The existing data establishing the safety and efficacy of these novel agents will be the focus of this review.
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References
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Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999;341:577–85.
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128:e240–327.
Gupta D, Georgiopoulou VV, Kalogeropoulos AP, et al. Dietary sodium intake in heart failure. Circulation. 2012;126:479–85. This review summarizes the studies assessing the effects of sodium restriction in HF, highlighting knowledge gaps and future directions.
Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797–805. This prospective, randomized trial we assigned patients with acute decompensated heart failure to receive furosemide administered intravenously by means of either a bolus every 12 h or continuous infusion and at either a low or high dose. This is one of the few prospective studies examining diuretic strategies in acute decompensated heart failure.
Stanton BA, Kaissling B. Adaptation of distal tubule and collecting duct to increased Na delivery. II. Na+ and K+ transport. Am J Physiol Ren Physiol. 1988;255:F1269–75.
Investigators S. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.
Garg R, Yusuf S, Bussmann WD, et al. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA. 1995;273:1450–6.
Maggioni AP, Anand I, Gottlieb SO, Latini R, Tognoni G, Cohn JN. Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors. J Am Coll Cardiol. 2002;40:1414–21.
Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709–17.
Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309–21.
Zannad F, McMurray JJV, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2010;364:11–21.
Hillege HL, Nitsch D, Pfeffer MA, et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation. 2006;113:671–8. This substudy of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program examined the impact of impaired renal function on major adverse cardiovascular outcomes in patients with heart failure with both preserved as well as reduced ejection fraction.
Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. 2004;351:543–51. This post hoc analysis demonstrated significant increases in the rate of prescriptions for spironolactone and in hyperkalemia-associated morbidity and mortality after publication of the Randomized Aldactone Evaluation Study, leading to alterations of the guidelines for closer laboratory monitoring.
Zachariah D, Kalra PR. Managing patients with cardiorenal syndrome: time to look to the gut? Eur J Heart Fail. 2012;14:870–2.
Lopes RJ, Lourenco AP, Mascarenhas J, Azevedo A, Bettencourt P. Safety of spironolactone use in ambulatory heart failure patients. Clin Cardiol. 2008;31:509–13.
Vardeny O, Claggett B, Anand I, et al. Incidence, predictors, and outcomes related to hypo- and hyperkalemia in patients with severe heart failure treated with a mineralocorticoid receptor antagonist. Circulation: Heart Fail. 2014;7:573–9.
Vardeny O, Wu DH, Desai A, et al. Influence of baseline and worsening renal function on efficacy of spironolactone in patients with severe heart failure: insights from RALES (Randomized Aldactone Evaluation Study). J Am Coll Cardiol. 2012;60:2082–9. This post hoc analysis from the RALES trial examined the efficacy of spironolactone in patients with worsening renal function and baseline renal impairment.
Heerspink H, Gao P, Zeeuw D, et al. The effect of ramipril and telmisartan on serum potassium and its association with cardiovascular and renal events: results from the ONTARGET trial. Eur J Prev Cardiol. 2014;21:299–309.
Sadjadi S, McMillan J, Jaipaul N, Blakely P, Hline S. A comparative study of the prevalence of hyperkalemia with the use of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers. Ther Clin Risk Manag. 2009;5:547–52.
McAlister FA, Zhang J, Tonelli M, Klarenbach S, Manns BJ, Hemmelgarn BR. The safety of combining angiotensin-converting-enzyme inhibitors with angiotensin-receptor blockers in elderly patients: a population-based longitudinal analysis. Can Med Assoc J. 2011;183:655–62.
Pitt B, Anker SD, Bushinsky DA, Kitzman DW, Zannad F, Huang IZ. Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J. 2011;32:820–8. This randomized study evaluated the efficacy and safety of RLY5016 on serum K+ levels in patients with chronic heart failure (HF) receiving standard therapy and spironolactone.
Desai A. Hyperkalemia associated with inhibitors of the renin-angiotensin-aldosterone system: balancing risk and benefit. Circulation. 2008;118:1609–11.
Henderson LW, Dittrich HC, Strickland A, et al. A phase 1 dose-ranging study examining the effects of a superabsorbent polymer (CLP) on fluid, sodium and potassium excretion in healthy subjects. BMC Pharmacol Toxicol. 2014;15:1–7.
Costanzo MR, Heywood JT, Massie BM, et al. A double-blind, randomized, parallel, placebo-controlled study examining the effect of cross-linked polyelectrolyte in heart failure patients with chronic kidney disease. Eur J Heart Fail. 2012;14:922–30. This randomized study evaluated the efficacy of cross-linked polyelectrolyte (CLP) on serum electrolytes and measures of congestion in patients with heart failure and chronic kidney disease.
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Alanna A. Morris declares that she has no conflict of interest.
Robert T. Cole declares that he has no conflict of interest.
Javed Butler serves as a consultant to Bayer and Relypsa.
Divya Gupta declares that she has no conflict of interest.
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Morris, A.A., Cole, R.T., Butler, J. et al. Oral Sodium and Potassium Binders in Heart Failure. Curr Heart Fail Rep 12, 107–111 (2015). https://doi.org/10.1007/s11897-014-0248-y
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DOI: https://doi.org/10.1007/s11897-014-0248-y