Short communicationDoes moderate hyperkalemia influence survival in HF? Insights from the MECKI score data base☆
Introduction
In reduced ejection fraction (HFrEF) heart failure patients, hyperkalemia has been reported up to 18% of cases with a higher incidence in patients with more severe HF [1].
Several mechanisms have been advocated as causes of hyperkalemia including both pathophysiological alterations and iatrogenic factors [2]. Moreover, some frequently observed HF comorbidities, such as diabetes and renal failure, by reducing K+ elimination in the kidney, are reported as hyperkalemia causes [3,4]. Finally, renin angiotensin aldosterone system inhibitor (RAASi) therapy, which is recommended as a disease modifier HF therapy [5], may further increase the risk of hyperkalemia in HFrEF [1,6,7]. Consequently, in case of hyperkalemia RAASi therapy is usually down-titrated or discontinued [5,8].
However, the effect of moderate hyperkalemia in determining HFrEF prognosis is still controversial albeit a few studies suggest that hyperkalemia is associated with poor prognosis, arrhythmias, intensive care admission and death [[9], [10], [11]]. Specifically, the prognostic role of moderate hyperkalemia in well characterized HFrEF patients is basically unknown.
The aim of our study is to assess the prognostic role of moderate hyperkalemia in a large cohort of ambulatory optimally treated chronic HFrEF patients. We performed a post-hoc analysis of MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score database to investigate whether moderately elevated potassium levels, between 5.0 and 5.5 meq/L, independently affected long-term survival.
Section snippets
Methods
We retrospectively analyzed data from MECKI score database, which includes a cohort of patients with a history of HFrEF recruited between 1993 and 2020 and prospectively followed [12]. MECKI score inclusion/exclusion criteria and follow up modalities were previously reported in details [12]. In brief, MECKI score inclusion/exclusion criteria were: history of HFrEF [left ventricle (LV) EF < 40%], clinical stability and optimized HF treatment and ability to perform a cardiopulmonary exercise
Results
The studied population included 484 couplets of stable and optimally treated chronic HFrEF patients (Table 1). In normal K+ patients (K+ ≥ 4.0 and < 5.0 mEq/L) average daily diuretic dose was 50 [25.0–75.0] mg and carvedilol equivalent β-blockers dosage was 18.75 [12.5–25.0] mg while in high K+ patients (K+ ≥ 5and ≤5.5 mEq/L) diuretic dose was 50 [25.0–100.0] mg (p = 0.748) and equivalent β-blockers dosage was 12.5 [12.5–25.0] mg (p = 0.162). HF etiology was ischemic in around 50% of cases and
Discussion
Results of the present study spread some light on the field of moderate hyperkalemia in HF showing that per se moderate hyperkalemia is not associated to a worst outcome provided that patients have been properly matched for clinical characteristics, HF severity and treatment. Accordingly, our findings are similar to those of Beusekamp et al. [14] who, differently from several other reports [[9], [10], [11]] showed that hyperkalemia was not associated with adverse outcomes but associated to a
Declaration of Competing Interest
None to declare.
Acknowledgement
The present study was funded by the Italian Ministry of Health (Ricerca Corrente).
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All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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see appendix.