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Serum potassium dynamics during acute heart failure hospitalization

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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).

Author information

Authors and Affiliations

  1. CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain

    Pedro Caravaca Perez, José R. González-Juanatey, Jorge Nuche, Laura Morán Fernández, Jesús Alvarez-García, Manuel Martínez Selles, Luis Martínez Dolz, Marta Cobo-Marcos, Domingo Pascual Figal, Maria G. Crespo-Leiro, Julio Nuñez Villota & Juan F. Delgado

  2. Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Avenida de Andalucía s/n, 28041, Madrid, Spain

    Pedro Caravaca Perez, Laura Morán Fernández & Juan F. Delgado

  3. Department of Cardiology, Complejo Hospitalario Universitario de Santiago de Compostela, Facultad de Medicina, Universidad de Santiago, Santiago de Compostela, Spain

    José R. González-Juanatey

  4. Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain

    Jorge Nuche & Juan Cinca Cuscullola

  5. Instituto de Investigación Sanitaria Hospital 12 Octubre (imas12), Universidad Complutense de Madrid, CIBERESP, Madrid, Spain

    David Lora Pablos

  6. Department of Cardiology, Hospital Universitario Santa Creu i Sant Pau, Universidad de Barcelona, Barcelona, Spain

    Jesús Alvarez-García

  7. Hospital Universitari Arnau de Vilanova, IBRLLEIDA, Lleida, Spain

    Ramón Bascompte Claret

  8. Department of Cardiology, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria IiGM, Universidad Europea, Madrid, Spain

    Manuel Martínez Selles

  9. UGC de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain

    Rafael Vázquez García

  10. Department of Cardiology, Hospital Universitario Y Politécnico La Fe, IIS La Fe, Valencia, Spain

    Luis Martínez Dolz

  11. Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain

    Marta Cobo-Marcos

  12. Department of Cardiology, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, Murcia, Spain

    Domingo Pascual Figal

  13. Department of Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomedica A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain

    Maria G. Crespo-Leiro

  14. Servicio de Cardiología, Hospital Clinico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain

    Julio Nuñez Villota

  15. Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain

    Juan F. Delgado

Authors
  1. Pedro Caravaca Perez
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  2. José R. González-Juanatey
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  3. Jorge Nuche
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  6. Jesús Alvarez-García
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  7. Ramón Bascompte Claret
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  8. Manuel Martínez Selles
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  9. Rafael Vázquez García
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  10. Luis Martínez Dolz
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  12. Domingo Pascual Figal
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  13. Maria G. Crespo-Leiro
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  14. Julio Nuñez Villota
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  15. Juan Cinca Cuscullola
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  16. Juan F. Delgado
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Corresponding author

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 111, 368–379 (2022). https://doi.org/10.1007/s00392-020-01753-3

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  • DOI: https://doi.org/10.1007/s00392-020-01753-3

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