Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications

GREAT (Global Research on Acute Conditions Team) Network and INI-CRCT (Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists) network

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Background: The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown. Methods: Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes. Results: Positive and negative linear relationships between 90-day mortality and sK+ above 4.5 mmol/L (hyperkalemia) and below 3.5 mmol/L (hypo-kalemia) were observed. Hazard ratio for death was 1.46 [1.34–1.58] for hyperkalemia and 1.22 [1.06–1.40] for hypokalemia. In a fully adjusted model, only hyperkalemia remained associated with mortality (HR 1.03 [1.02–1.04] for each 0.1 mmol/l change of sK+ above 4.5 mmol/L). Interaction tests revealed that the association between hyperkalemia and outcome was significantly affected by chronic medications. The association between hyperkalemia and mortality was absent for patients treated with beta blockers and in those with preserved renal function. Conclusions: In patients with AHF, sK+ > 4.5 mmol/L appears to be associated with 90-day mortality. B-blockers have potentially a protective effect in the setting of hyperkalemia.

Original languageEnglish
Pages (from-to)214-221
Number of pages8
JournalClinical Research in Cardiology
Volume107
Issue number3
DOIs
StatePublished - 1 Mar 2018

Keywords

  • B-blockers
  • Heart failure
  • Mortality
  • Potassium
  • Renal failure

Cite this

GREAT (Global Research on Acute Conditions Team) Network and INI-CRCT (Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists) network (2018). Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications. Clinical Research in Cardiology, 107(3), 214-221. https://doi.org/10.1007/s00392-017-1173-3