Hyperkalemia, clinical outcomes, and mineralocorticoid receptor antagonist in heart failure: insights from the REVIEW-HF registry
J Aoki, T Nasu, S Ishii, N Kagiyama, K Kida, W Fujimoto, A Kikuchi, T Ijichi, T Shibata, T Ikeda, K Kanaoka, S MatsumotoAbstract
Background
The relationship between hyperkalemia and clinical outcomes is unclear, especially its interaction with mineralocorticoid receptor antagonist (MRA) use in patients with heart failure (HF).
Methods
We analyzed data from a nationwide, multicenter (17 hospitals), Japanese registry (REVIEW-HF). Patients were divided into four groups according to baseline potassium levels: hypokalemia (≤3.7 mEq/L), low-normal (3.8–4.4 mEq/L), high-normal (4.5–4.9 mEq/L), and hyperkalemia (≥5.0 mEq/L). The primary outcome, a composite of cardiovascular death or HF hospitalization, was analyzed according to baseline MRA use.
Results
Baseline potassium levels were available in 994 patients (132 hypokalemia, 532 low-normal, 229 high-normal, and 101 hyperkalemia). Compared to those with lower potassium levels (i.e., hypokalemia, low-normal, and high-normal), patients with hyperkalemia (≥5.0 mEq/L) had a better prognosis (P=0.02) (Figure A). As a continuous variable, higher potassium levels were also associated with a lower risk of the primary outcome (Figure B). By contrast, a similar relationship was observed in MRA users (P=0.04), but not in non-users (P=0.53) (Figure C and D).
Conclusions
Potassium levels were predictive of HF outcomes, with higher levels being associated with better clinical outcomes, even in the range of hyperkalemia. However, this trend was seen only in MRA users.For image description, please refer to the figure legend and surrounding text.