Hyperkalemia and management of renin-angiotensin-aldosterone system inhibitors in chronic heart failure with reduced ejection fraction: A systematic review.
Rev Port Cardiol (Engl Ed)
; 39(9): 517-541, 2020 Sep.
Article
en En, Pt
| MEDLINE
| ID: mdl-32868174
ABSTRACT
INTRODUCTION AND OBJECTIVES:
Renin-angiotensin-aldosterone system inhibitors (RAASi) are the cornerstone of treatment of heart failure with reduced ejection fraction (HFrEF). RAASi optimization in real-life care is challenged by hyperkalemia, a potentially fatal adverse event, which can necessitate downtitration or discontinuation of RAASi and negatively impact survival in HFrEF. The literature on this problem is sparse. We performed a systematic review of studies on HFrEF to investigate the prevalence, incidence, and risk factors of hyperkalemia, RAASi prescription rates, frequency of RAASi downtitration or discontinuation due to hyperkalemia, and the potential negative effect of the latter on prognosis.METHODS:
We conducted a MEDLINE (PubMed) search including observational and interventional studies published between January 1987 and May 2018.RESULTS:
A total of 30 observational and 18 interventional studies were included in the review. The incidence of hyperkalemia reported was between 0% and 63% in observational studies and was between 0% and 30% in clinical trials. Risk factors for hyperkalemia included RAASi prescription, older age, diabetes, and chronic kidney disease. In real-life studies, RAASi were downtitrated or discontinued in 3-22% of HFrEF patients; hyperkalemia was the reported cause in 5% of cases. No reports were found on the impact on prognosis of RAASi downtitration or discontinuation due to hyperkalemia.CONCLUSIONS:
Hyperkalemia and RAASi downtitration or discontinuation are frequent, particularly in real-life HFrEF studies. Further research is needed to clarify the role of RAASi downtitration or discontinuation due to hyperkalemia and to assess its long-term prognostic impact in HFrEF patients.Palabras clave
Clinical decision-making; Clinical outcomes; Drug therapy; Heart failure; Hipercaliemia; Hyperkalemia; Inibidores do sistema renina-angiotensina-aldosterona; Insuficiência cardíaca; Renin-angiotensin-aldosterone system inhibitors; Resultados clínicos; Terapêutica medicamentosa; Tomada de decisão clínica
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Sistema Renina-Angiotensina
/
Insuficiencia Cardíaca
/
Hiperpotasemia
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Límite:
Aged
/
Humans
Idioma:
En
/
Pt
Revista:
Rev Port Cardiol (Engl Ed)
Año:
2020
Tipo del documento:
Article