Serum potassium dynamics during acute heart failure hospitalization.
Dyskalemia
Heart failure
Hyperkalemia
Hypokalemia
Potassium
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
01
08
2020
accepted:
30
09
2020
pubmed:
19
10
2020
medline:
5
4
2022
entrez:
18
10
2020
Statut:
ppublish
Résumé
Available information about prognostic implications of potassium levels alteration in the setting of acute heart failure (AHF) is scarce. We aim to describe the prevalence of dyskalemia (hypo or hyperkalemia), its dynamic changes during AHF-hospitalization, and its long-term clinical impact after hospitalization. We analyzed 1779 patients hospitalized with AHF who were included in the REDINSCOR II registry. Patients were classified in three groups, according to potassium levels both on admission and discharge: hypokalemia (potassium < 3.5 mEq/L), normokalemia (potassium = 3.5-5.0 mEq/L and, hyperkalemia (potassium > 5 mEq/L). The prevalence of hypokalemia and hyperkalemia on admission was 8.2 and 4.6%, respectively, and 6.4 and 2.7% at discharge. Hyperkalemia on admission was associated with higher in-hospital mortality (OR = 2.32 [95% CI: 1.04-5.21] p = 0.045). Among patients with hypokalemia on admission, 79% had normalized potassium levels at discharge. In the case of patients with hyperkalemia on admission, 89% normalized kalemia before discharge. In multivariate Cox regression, dyskalemia was associated with higher 12-month mortality, (HR = 1.48 [95% CI, 1.12-1.96], p = 0.005). Among all patterns of dyskalemia persistent hypokalemia (HR = 3.17 [95% CI: 1.71-5.88]; p < 0.001), and transient hyperkalemia (HR = 1.75 [95% CI: 1.07-2.86]; p = 0.023) were related to reduced 12-month survival. Potassium levels alterations are frequent and show a dynamic behavior during AHF admission. Hyperkalemia on admission is an independent predictor of higher in-hospital mortality. Furthermore, persistent hypokalemia and transient hyperkalemia on admission are independent predictors of 12-month mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Available information about prognostic implications of potassium levels alteration in the setting of acute heart failure (AHF) is scarce.
OBJECTIVES
OBJECTIVE
We aim to describe the prevalence of dyskalemia (hypo or hyperkalemia), its dynamic changes during AHF-hospitalization, and its long-term clinical impact after hospitalization.
METHODS
METHODS
We analyzed 1779 patients hospitalized with AHF who were included in the REDINSCOR II registry. Patients were classified in three groups, according to potassium levels both on admission and discharge: hypokalemia (potassium < 3.5 mEq/L), normokalemia (potassium = 3.5-5.0 mEq/L and, hyperkalemia (potassium > 5 mEq/L).
RESULTS
RESULTS
The prevalence of hypokalemia and hyperkalemia on admission was 8.2 and 4.6%, respectively, and 6.4 and 2.7% at discharge. Hyperkalemia on admission was associated with higher in-hospital mortality (OR = 2.32 [95% CI: 1.04-5.21] p = 0.045). Among patients with hypokalemia on admission, 79% had normalized potassium levels at discharge. In the case of patients with hyperkalemia on admission, 89% normalized kalemia before discharge. In multivariate Cox regression, dyskalemia was associated with higher 12-month mortality, (HR = 1.48 [95% CI, 1.12-1.96], p = 0.005). Among all patterns of dyskalemia persistent hypokalemia (HR = 3.17 [95% CI: 1.71-5.88]; p < 0.001), and transient hyperkalemia (HR = 1.75 [95% CI: 1.07-2.86]; p = 0.023) were related to reduced 12-month survival.
CONCLUSIONS
CONCLUSIONS
Potassium levels alterations are frequent and show a dynamic behavior during AHF admission. Hyperkalemia on admission is an independent predictor of higher in-hospital mortality. Furthermore, persistent hypokalemia and transient hyperkalemia on admission are independent predictors of 12-month mortality.
Identifiants
pubmed: 33070219
doi: 10.1007/s00392-020-01753-3
pii: 10.1007/s00392-020-01753-3
doi:
Substances chimiques
Potassium
RWP5GA015D
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
368-379Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Sayago-Silva I, García-López F, Segovia-Cubero J (2013) Epidemiología de la insuficiencia cardiaca en España en los últimos 20 años. Rev Española Cardiol 66:649–656. https://doi.org/10.1016/j.recesp.2013.03.014
doi: 10.1016/j.recesp.2013.03.014
Mentz RJ, O’Connor CM (2016) Pathophysiology and clinical evaluation of acute heart failure. Nat Rev Cardiol 13:28–35. https://doi.org/10.1038/nrcardio.2015.134
doi: 10.1038/nrcardio.2015.134
pubmed: 26370473
Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129–2200m. https://doi.org/10.1093/eurheartj/ehw128
doi: 10.1093/eurheartj/ehw128
Urso C, Brucculeri S, Caimi G (2015) Acid–base and electrolyte abnormalities in heart failure: pathophysiology and implications. Heart Fail Rev 20:493–503. https://doi.org/10.1007/s10741-015-9482-y
doi: 10.1007/s10741-015-9482-y
pubmed: 25820346
pmcid: 4464645
Komajda M, Anker SD, Cowie MR et al (2016) Physicians’ adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. Eur J Heart Fail 18:514–522. https://doi.org/10.1002/ejhf.510
doi: 10.1002/ejhf.510
pubmed: 27095461
Núñez J, Bayés-Genís A, Zannad F et al (2018) Long-term potassium monitoring and dynamics in heart failure and risk of mortality. Circulation 137:1320–1330. https://doi.org/10.1161/CIRCULATIONAHA.117.030576
doi: 10.1161/CIRCULATIONAHA.117.030576
pubmed: 29025765
Khan SS, Campia U, Chioncel O et al (2015) Changes in serum potassium levels during hospitalization in patients with worsening heart failure and reduced ejection fraction (from the EVEREST trial). Am J Cardiol 115:790–796. https://doi.org/10.1016/j.amjcard.2014.12.045
doi: 10.1016/j.amjcard.2014.12.045
pubmed: 25728846
Salah K, Pinto YM, Eurlings LW et al (2015) Serum potassium decline during hospitalization for acute decompensated heart failure is a predictor of 6-month mortality, independent of N-terminal pro-B-type natriuretic peptide levels: an individual patient data analysis. Am Heart J 170:531-542.e1. https://doi.org/10.1016/j.ahj.2015.06.003
doi: 10.1016/j.ahj.2015.06.003
pubmed: 26385037
Formiga F, Chivite D, Corbella X et al (2019) Influence of potassium levels on one-year outcomes in elderly patients with acute heart failure. Eur J Intern Med 60:24–30. https://doi.org/10.1016/j.ejim.2018.10.016
doi: 10.1016/j.ejim.2018.10.016
pubmed: 30722845
Haukoos JS, Newgard CD (2007) Advanced statistics: missing data in clinical research—part 1: an introduction and conceptual framework. Acad Emerg Med 14:662–668. https://doi.org/10.1197/j.aem.2006.11.037
doi: 10.1197/j.aem.2006.11.037
pubmed: 17538078
Newgard CD, Haukoos JS (2007) Advanced statistics: missing data in clinical research—part 2: multiple imputation. Acad Emerg Med 14:669–678. https://doi.org/10.1197/j.aem.2006.11.038
doi: 10.1197/j.aem.2006.11.038
pubmed: 17595237
Hoss S, Elizur Y, Luria D et al (2016) Serum potassium levels and outcome in patients with chronic heart failure. Am J Cardiol 118:1868–1874. https://doi.org/10.1016/j.amjcard.2016.08.078
doi: 10.1016/j.amjcard.2016.08.078
pubmed: 27726855
Davidsen L, Aldahl M, Krogager ML et al (2017) Associations of serum potassium levels with mortality in chronic heart failure patients. Eur Heart J 38:2890–2896. https://doi.org/10.1093/eurheartj/ehx460
doi: 10.1093/eurheartj/ehx460
pubmed: 29019614
Crespo-Leiro MG, Barge-Caballero E, Segovia-Cubero J et al (2019) Hyperkalemia in heart failure patients in Spain and its impact on guideline- directed medical therapy. Rev Esp Cardiol. https://doi.org/10.1016/j.recesp.2019.05.004
doi: 10.1016/j.recesp.2019.05.004
pubmed: 31761573
Tromp J, ter Maaten JM, Damman K et al (2017) Serum potassium levels and outcome in acute heart failure (data from the PROTECT and COACH trials). Am J Cardiol 119:290–296. https://doi.org/10.1016/j.amjcard.2016.09.038
doi: 10.1016/j.amjcard.2016.09.038
pubmed: 27823598
Legrand M, Ludes PO, Massy Z et al (2018) Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications. Clin Res Cardiol 107:214–221. https://doi.org/10.1007/s00392-017-1173-3
doi: 10.1007/s00392-017-1173-3
pubmed: 29080909
Bielecka-Dabrowa A, Mikhailidis DP, Jones L et al (2012) The meaning of hypokalemia in heart failure. Int J Cardiol 158:12–17. https://doi.org/10.1016/j.ijcard.2011.06.121
doi: 10.1016/j.ijcard.2011.06.121
pubmed: 21775000
Ferreira JP, Butler J, Rossignol P et al (2020) Abnormalities of potassium in heart failure: JACC state-of-the-art review. J Am Coll Cardiol 75:2836–2850. https://doi.org/10.1016/j.jacc.2020.04.021
doi: 10.1016/j.jacc.2020.04.021
pubmed: 32498812
Girerd N, Pang PS, Swedberg K et al (2013) Serum aldosterone is associated with mortality and re-hospitalization in patients with reduced ejection fraction hospitalized for acute heart failure: analysis from the EVEREST trial. Eur J Heart Fail 15:1228–1235. https://doi.org/10.1093/eurjhf/hft100
doi: 10.1093/eurjhf/hft100
pubmed: 23787720