Frequency of Hyperkalemia in Patients Presenting with Heart Failure with Reduced Ejection Fraction at Tertiary Care Hospital Karachi
DOI:
https://doi.org/10.61919/jhrr.v4i2.838Keywords:
Chronic Heart Failure, Hyperkalemia, HFrEF, Serum Potassium, Renin-Angiotensin-Aldosterone System Inhibitors, Cardiac ArrhythmiasAbstract
Background: Hyperkalemia, characterized by elevated serum potassium levels greater than 5.0 mmol/L, poses significant risks for patients due to its potential to induce cardiac arrhythmias and conduction abnormalities. This condition is particularly prevalent among patients with chronic conditions such as kidney disease, heart failure (HF), and diabetes, especially those treated with renin-angiotensin-aldosterone system inhibitors (RAASi). While these medications are beneficial for heart failure management, they can exacerbate renal dysfunction and hyperkalemia, both associated with poor clinical outcomes.
Objective: The study aimed to determine the frequency of hyperkalemia among patients presenting with chronic heart failure with reduced ejection fraction (HFrEF) at a tertiary care facility in Karachi.
Methods: A cross-sectional study was conducted at the Department of Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, from August 22, 2020, to February 21, 2021. The study enrolled 139 patients aged between 20 and 70 years diagnosed with HFrEF based on echocardiography findings. Informed consent was obtained from all participants. Comprehensive clinical evaluations and laboratory measurements of serum potassium were performed to identify hyperkalemia. Data collection included demographic information, clinical history, comorbid conditions, and serum potassium levels. The data were analyzed using SPSS Version 25, with descriptive statistics summarizing demographic characteristics and chi-square tests assessing the relationships between hyperkalemia and patient characteristics.
Results: The mean age of the study cohort was 58.4 ± 15.9 years, with a male predominance of 55.4%. Dyslipidemia was observed in 30.2% of the participants. Hyperkalemia was found in 39.6% of the patients. The analysis showed no significant correlation between hyperkalemia and gender (p=0.991), hypertension (p=0.948), dyslipidemia (p=0.098), monthly income (p=0.770), or smoking status (p=0.853).
Conclusion: Hyperkalemia is significantly prevalent in patients with chronic heart failure and reduced ejection fraction. Routine screening and management of serum potassium levels are crucial in this patient population to mitigate the risks associated with hyperkalemia and optimize heart failure management.
Downloads
References
Juillière Y, Venner C, Filippetti L, Popovic B, Huttin O, Selton-Suty C. Heart Failure With Preserved Ejection Fraction: A Systemic Disease Linked to Multiple Comorbidities, Targeting New Therapeutic Options. Arch Cardiovasc Dis. 2018;111(12):766-81.
Sapna F, Raveena F, Chandio M, Bai K, Sayyar M, Varrassi G, et al. Advancements in Heart Failure Management: A Comprehensive Narrative Review of Emerging Therapies. Adv Ther. 2023;15(10).
Pagel PS, Tawil JN, Boettcher BT, Izquierdo DA, Lazicki TJ, Crystal GJ, et al. Heart Failure With Preserved Ejection Fraction: A Comprehensive Review and Update of Diagnosis, Pathophysiology, Treatment, and Perioperative Implications. J Cardiothorac Vasc Anesth. 2021;35(6):1839-59.
Zakeri R, Cowie MR. Heart Failure With Preserved Ejection Fraction: Controversies, Challenges and Future Directions. Heart. 2018;104(5):377-84.
Wintrich J, Kindermann I, Ukena C, Selejan S, Werner C, Maack C, et al. Therapeutic Approaches in Heart Failure With Preserved Ejection Fraction: Past, Present, and Future. Clin Res Cardiol. 2020;109:1079-98.
Plitt GD, Spring JT, Moulton MJ, Agrawal DK. Mechanisms, Diagnosis, and Treatment of Heart Failure With Preserved Ejection Fraction and Diastolic Dysfunction. Expert Rev Cardiovasc Ther. 2018;16(8):579-89.
Rosano GM, Tamargo J, Kjeldsen KP, Lainscak M, Agewall S, Anker SD, et al. Expert Consensus Document on the Management of Hyperkalemia in Patients With Cardiovascular Disease Treated With Renin Angiotensin Aldosterone System Inhibitors: Coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother. 2018;4(3):180-8.
Shah SR, Winchester DE. The Impact of Chronic Kidney Disease on Medication Choice and Pharmacologic Management in Patients With Heart Failure. Expert Rev Clin Pharmacol. 2018;11(6):571-9.
Rossignol P, Ruilope LM, Cupisti A, Ketteler M, Wheeler DC, Pignot M, et al. Recurrent Hyperkalemia Management and Use of Renin-Angiotensin-Aldosterone System Inhibitors: A European Multi-National Targeted Chart Review. Eur J Heart Fail. 2020;13(4):714-9.
Mishra S, Kass DA. Cellular and Molecular Pathobiology of Heart Failure With Preserved Ejection Fraction. Nat Rev Cardiol. 2021;18(6):400-23.
Borovac JA, D'Amario D, Bozic J, Glavas D. Sympathetic Nervous System Activation and Heart Failure: Current State of Evidence and the Pathophysiology in the Light of Novel Biomarkers. World J Cardiol. 2020;12(8):373.
King J. Pathophysiology of Heart Failure. In: Managing Heart Failure in Primary Care: A Case Study Approach. Springer; 2023. p. 3-11.
Ogunniyi MO, Commodore-Mensah Y, Ferdinand KC. Race, Ethnicity, Hypertension, and Heart Disease: JACC Focus Seminar 1/9. J Am Coll Cardiol. 2021;78(24):2460-70.
Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M, et al. Global Epidemiology of Valvular Heart Disease. Nat Rev Cardiol. 2021;18(12):853-64.
Scarà A, Palamà Z, Robles AG, Dei L-L, Borrelli A, Zanin F, et al. Non-Pharmacological Treatment of Heart Failure—From Physical Activity to Electrical Therapies: A Literature Review. Int J Environ Res Public Health. 2024;11(4):122.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):1757-80.
Ferreira JP, Duarte K, McMurray JJ, Pitt B, van Veldhuisen DJ, Vincent J, et al. Data-Driven Approach to Identify Subgroups of Heart Failure With Reduced Ejection Fraction Patients With Different Prognoses and Aldosterone Antagonist Response Patterns. JAMA Cardiol. 2018;11(7).
Linde C, Bakhai A, Furuland H, Evans M, McEwan P, Ayoubkhani D, et al. Real-World Associations of Renin-Angiotensin-Aldosterone System Inhibitor Dose, Hyperkalemia, and Adverse Clinical Outcomes in a Cohort of Patients With New-Onset Chronic Kidney Disease or Heart Failure in the United Kingdom. ESC Heart Fail. 2019;8(22).
Holmdahl AJ, Wessberg G, Norberg H, Söderström A, Valham F, Bergdahl E, et al. Motives, Frequency, Predictors and Outcomes of MRA Discontinuation in a Real-World Heart Failure Population. Eur J Heart Fail. 2022;9(2).
Ferreira JP, Butler J, Rossignol P, Pitt B, Anker SD, Kosiborod M, et al. Abnormalities of Potassium in Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(22):2836-50.
Hundemer GL, Sood MM. Hyperkalemia With RAAS Inhibition: Mechanism, Clinical Significance, and Management. Prog Cardiovasc Dis. 2021;172:105835.
Charkviani M, Krisanapan P, Thongprayoon C, Craici IM, Cheungpasitporn W. Systematic Review of Cardiovascular Benefits and Safety of Sacubitril-Valsartan in End-Stage Kidney Disease. Kidney Int Rep. 2023.
Chang H-H, Chiang J-H, Tsai C-C, Chiu P-F. Predicting Hyperkalemia in Patients With Advanced Chronic Kidney Disease Using the XGBoost Model. BMC Nephrol. 2023;24(1):169.
Akbar RR. Hyperkalemia-Related Renin Angiotensin-Aldosterone System Inhibitors: Mechanism, Clinical Significance, and Management. Eur J Med Res. 2023;1(9):555-68.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Aadil Memon, Asmat Mustafa, Umera Ali, Sattar Jamali, Ishaq, Rakesh
This work is licensed under a Creative Commons Attribution 4.0 International License.
