The Present and Future
Review Topic of the Week
Hyperkalemia in Heart Failure

https://doi.org/10.1016/j.jacc.2016.06.060Get rights and content
Under an Elsevier user license
open archive

Abstract

Disorders of potassium homeostasis can potentiate the already elevated risk of arrhythmia in heart failure. Heart failure patients have a high prevalence of chronic kidney disease, which further heightens the risk of hyperkalemia, especially when renin-angiotensin-aldosterone system inhibitors are used. Acute treatment for hyperkalemia may not be tolerated in the long term. Recent data for patiromer and sodium zirconium cyclosilicate, used to treat and prevent high serum potassium levels on a more chronic basis, have sparked interest in the treatment of hyperkalemia, as well as the potential use of renin-angiotensin-aldosterone system inhibitors in patients who were previously unable to take these drugs or tolerated only low doses. This review discusses the epidemiology, pathophysiology, and outcomes of hyperkalemia in heart failure; provides an overview of traditional and novel ways to approach management of hyperkalemia; and discusses the need for further research to optimally treat heart failure.

Key Words

angiotensin-converting enzyme inhibitors
angiotensin-receptor blockers
chronic kidney disease
mineralocorticoid receptor antagonist
patiromer
sodium zirconium cyclosilicate

Abbreviations and Acronyms

ACEi
angiotensin-converting enzyme inhibitor
ARB
angiotensin receptor blocker
CKD
chronic kidney disease
eGFR
estimated glomerular filtration rate
HF
heart failure
MRA
mineralocorticoid receptor antagonist
RAASi
renin-angiotensin-aldosterone system inhibitor
ZS-9
sodium zirconium cyclosilicate

Cited by (0)

Dr. Pitt is a compensated board member for Novartis; consultant for Takeda, AstraZeneca, Boehringer-Ingelheim, GE Healthcare, Relypsa, BG Medicine, Nile Therapeutics, Merck, Forest Laboratories, and Novartis; has received grant support from Forest Laboratories and Novartis; and holds stock in Relypsa, BG Medicine, Nile Therapeutics, and Aurasenc. Dr. Piña is a consultant for the U.S. Food and Drug Administration; and is on the advisory board of Novartis. Dr. Zannad is a compensated board member for Boston Scientific; consultant for Novartis, Takeda, AstraZeneca, Boehringer-Ingelheim, GE Healthcare, Relypsa, Servier, Boston Scientific, Bayer, Johnson & Johnson, and Resmed; and is a compensated speaker with Pfizer and AstraZeneca. Dr. Anker has received honoraria from and is a consultant for ThermoFisher Scientific, Cardiorentis, Bayer HealthCare AG, ZS Pharma, Relypsa, Novartis Pharma AG, and Vifor Pharma. Dr. Gheorghiade has consulted for Abbott Laboratories, Astellas, AstraZeneca, Bayer HealthCare AG, CorThera, Cytokinetics, DebioPharm SA, Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Johnson & Johnson, Medtronic, Merck, Novartis Pharma AG, Otsuka Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, Sanofi, Sigma Tau, Solvay Pharmaceuticals, Takeda Pharmaceutical, and Trevena Therapeutics. Dr. Butler has received research support from the National Institutes of Health and the European Union; and is a consultant for Amgen, Bayer, Boehringer-Ingelheim, Cardiocell, Celladon, Novartis, Trevena, Relypsa, Z Pharma, and Zensun. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.

© 2016 by the American College of Cardiology Foundation. Published by Elsevier.