Dyskalemia, its patterns, and prognosis among patients with incident heart failure: A nationwide study of US veterans.
Black or African American
Aged
Blood Pressure
Cross-Sectional Studies
Diuretics
Female
Heart Failure
/ epidemiology
Humans
Hyperkalemia
/ blood
Hypokalemia
/ blood
Incidence
Longitudinal Studies
Male
Middle Aged
Potassium
/ blood
Prognosis
Risk Factors
United States
/ epidemiology
Veterans
White People
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
21
11
2018
accepted:
04
07
2019
entrez:
9
8
2019
pubmed:
9
8
2019
medline:
3
4
2020
Statut:
epublish
Résumé
Although hypokalemia has been viewed as a significant concern among patients with heart failure (HF), recent advances in HF management tend to increase the risk of hyperkalemia. To characterize contemporary data regarding correlates and prognostic values of dyskalemia in patients with HF. In cross-sectional and longitudinal analyses, we studied 142,087 patients with newly diagnosed HF in US nationwide Veterans Administration database from 2005 through 2013. Demographic characteristics, laboratory variables, comorbidities, and medication use for the analysis of correlates of dyskalemia as well as potassium level in the analysis of mortality. Dyskalemia and mortality. Hypokalemia (<3.5 mmol/L) at baseline was observed in 3.0% of the population, whereas hyperkalemia (≥5.5 mmol/L) was seen in 0.9%. An additional 20.4% and 5.7% had mild hypokalemia (3.5-3.9 mmol/L) and mild hyperkalemia (5.0-5.4 mmol/L). Key correlates were black race, higher blood pressure, and use of potassium-wasting diuretics for hypokalemia, and lower kidney function for hyperkalemia. Baseline potassium levels showed a U-shaped association with mortality, with the lowest risk between 4.0-4.5 mmol/L. With respect to potassium levels over a year after HF diagnosis, persistent (>50% of measurements), intermittent (>1 occurrence but ≤50%), and transient (1 occurrence) hypo- and hyperkalemia were also related to increased mortality in a graded fashion regardless of the aforementioned thresholds for dyskalemia. These dyskalemic patterns were also related to other clinical actions and demands such as emergency room visit. Potassium levels below 4 mmol/L and above 5 mmol/L at and after HF diagnosis were associated with poor prognosis and the clinical actions. HF patients (particularly with risk factors for dyskalemia like black race and kidney dysfunction) may require special attention for both hypo- and hyperkalemia.
Sections du résumé
BACKGROUND
Although hypokalemia has been viewed as a significant concern among patients with heart failure (HF), recent advances in HF management tend to increase the risk of hyperkalemia.
OBJECTIVE
To characterize contemporary data regarding correlates and prognostic values of dyskalemia in patients with HF.
DESIGN, SETTING, AND PARTICIPANTS
In cross-sectional and longitudinal analyses, we studied 142,087 patients with newly diagnosed HF in US nationwide Veterans Administration database from 2005 through 2013.
EXPOSURES
Demographic characteristics, laboratory variables, comorbidities, and medication use for the analysis of correlates of dyskalemia as well as potassium level in the analysis of mortality.
MAIN OUTCOMES AND MEASURES
Dyskalemia and mortality.
RESULTS
Hypokalemia (<3.5 mmol/L) at baseline was observed in 3.0% of the population, whereas hyperkalemia (≥5.5 mmol/L) was seen in 0.9%. An additional 20.4% and 5.7% had mild hypokalemia (3.5-3.9 mmol/L) and mild hyperkalemia (5.0-5.4 mmol/L). Key correlates were black race, higher blood pressure, and use of potassium-wasting diuretics for hypokalemia, and lower kidney function for hyperkalemia. Baseline potassium levels showed a U-shaped association with mortality, with the lowest risk between 4.0-4.5 mmol/L. With respect to potassium levels over a year after HF diagnosis, persistent (>50% of measurements), intermittent (>1 occurrence but ≤50%), and transient (1 occurrence) hypo- and hyperkalemia were also related to increased mortality in a graded fashion regardless of the aforementioned thresholds for dyskalemia. These dyskalemic patterns were also related to other clinical actions and demands such as emergency room visit.
CONCLUSIONS
Potassium levels below 4 mmol/L and above 5 mmol/L at and after HF diagnosis were associated with poor prognosis and the clinical actions. HF patients (particularly with risk factors for dyskalemia like black race and kidney dysfunction) may require special attention for both hypo- and hyperkalemia.
Identifiants
pubmed: 31393910
doi: 10.1371/journal.pone.0219899
pii: PONE-D-18-33479
pmc: PMC6687136
doi:
Substances chimiques
Diuretics
0
Potassium
RWP5GA015D
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0219899Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK100446
Pays : United States
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Circulation. 1999 Sep 21;100(12):1311-5
pubmed: 10491376
J Am Coll Cardiol. 2004 Jan 21;43(2):155-61
pubmed: 14736430
Eur Heart J. 2007 Jun;28(11):1334-43
pubmed: 17537738
J Am Coll Cardiol. 2007 Nov 13;50(20):1959-66
pubmed: 17996561
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Int J Cardiol. 2010 Oct 29;144(3):383-8
pubmed: 19500863
Postgrad Med J. 2010 Mar;86(1013):136-42
pubmed: 20237007
Can J Cardiol. 2010 Oct;26(8):306-12
pubmed: 20931099
Int J Cardiol. 2012 Jun 28;158(1):12-7
pubmed: 21775000
Circ Heart Fail. 2012 Mar 1;5(2):152-9
pubmed: 22271752
Heart Fail Rev. 2014 Mar;19(2):237-46
pubmed: 23135208
Ann Intern Med. 2013 Aug 20;159(4):233-42
pubmed: 24026256
Eur J Prev Cardiol. 2014 Mar;21(3):299-309
pubmed: 24191305
Br Heart J. 1987 Dec;58(6):572-82
pubmed: 2447925
Circ Heart Fail. 2014 Jul;7(4):573-9
pubmed: 24812304
J Vasc Surg. 2014 Sep;60(3):686-95.e2
pubmed: 24820900
Hypertension. 2014 Nov;64(5):951-7
pubmed: 25259744
JAMA Intern Med. 2015 Jun;175(6):996-1004
pubmed: 25895156
Circulation. 2015 Oct 20;132(16):1538-48
pubmed: 26384521
Hypertension. 2016 Jun;67(6):1181-8
pubmed: 27067721
Eur Heart J Cardiovasc Pharmacother. 2015 Oct;1(4):245-51
pubmed: 27418967
Am J Cardiol. 2016 Dec 15;118(12):1868-1874
pubmed: 27726855
Pharmacoepidemiol Drug Saf. 2017 Apr;26(4):421-428
pubmed: 28120359
J Am Soc Nephrol. 2017 Apr;28(4):1248-1258
pubmed: 28122944
Am J Kidney Dis. 2017 Aug;70(2):244-251
pubmed: 28363732
Circulation. 1985 Apr;71(4):645-9
pubmed: 3971535