Does moderate hyperkalemia influence survival in HF? Insights from the MECKI score data base. (15th January 2023)

• Record Type: Journal Article
• Authors: Toto, Federica; Salvioni, Elisabetta; Magrì, Damiano; Sciomer, Susanna; Piepoli, Massimo; Badagliacca, Roberto; Galotta, Arianna; Baracchini, Nikita; Paolillo, Stefania; Corrà, Ugo; Raimondo, Rosa; Lagioia, Rocco; Filardi, Pasquale Perrone; Iorio, Annamaria; Senni, Michele; Correale, Michele; Cicoira, Mariantonietta; Perna, Enrico; Metra, Marco; Guazzi, Marco; Limongelli, Giuseppe; Sinagra, Gianfranco; Parati, Gianfranco; Cattadori, Gaia; Bandera, Francesco; Bussotti, Maurizio; Mapelli, Massimo; Cipriani, Manlio; Bonomi, Alice; Cunha, Gonçalo; Re, Federica; Vignati, Carlo; Garascia, Andrea; Lombardi, Carlo; Scardovi, Angela B.; Passantino, Andrea; Emdin, Michele; Passino, Claudio; Santolamazza, Caterina; Girola, Davide; Zaffalon, Denise; Vizza, Dario; De Martino, Fabiana; Agostoni, Piergiuseppe;
• Is Part Of: International journal of cardiology. Volume 371(2023)
• Page Start: 273
• Page End: 277
• Publication Date: 2023-01-15
• Subjects: Heart failure -- Hyperkalemia -- Prognosis -- Renin angiotensin aldosterone system inhibitor; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.09.030
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The prognostic role of moderate hyperkalemia in reduced ejection fraction (HFrEF) patients is still controversial. Despite this, it affects the use of renin–angiotensin–aldosterone system inhibitors (RAASi) with therapy down-titration or discontinuation. Objectives: Aim of the study was to assess the prognostic impact of moderate hyperkalemia in chronic HFrEF optimally treated patients. Methods and results: We retrospectively analyzed MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) database, with median follow-up of 4.2 [IQR 1.9–7.5] years. Data on K + levels were available in 7087 cases. Patients with K + plasma level ≥ 5.6 mEq/L and < 4 mEq/L were excluded. Remaining patients were categorized into normal >4 and < 5 mEq/L ( n = 4826, 68%) and moderately high ≥5.0 and ≤ 5.5 mEq/L ( n = 496, 7%) K + . Then patients were matched by propensity score in 484 couplets of patients. MECKI score value was 7% [IQR 3.1–14.1%] and 7.3% [IQR 3.4–15%] ( p = 0.678) in patients with normal and moderately high K + values while cardiovascular mortality events at two years follow-up were 41 (4.2%) and 33 (3.4%) ( p = 0.333) in each group respectively. Conclusions: Moderate hyperkalemia does not influence patients' outcome in a large cohort of ambulatory HFrEF patients. Highlights: Hyperkalemia affects up to 18% of HFrEF patients leading to therapy down-titration. The prognostic role of moderate hyperkalemia is still controversial. We discovered that moderate hyperkalemia in HF is not associated to worst outcome.