Author + information
- Received March 9, 2020
- Revision received March 31, 2020
- Accepted April 2, 2020
- Published online June 1, 2020.
- João Pedro Ferreira, MD, PhDa,∗ (, )@CHRU_de_Nancy,
- Javed Butler, MD, MPH, MBAb,
- Patrick Rossignol, MD, PhDa,
- Bertram Pitt, MDc,
- Stefan D. Anker, MD, PhDd,
- Mikhail Kosiborod, MD, PhDe,f,
- Lars H. Lund, MD, PhDg,
- George L. Bakris, MDh,
- Matthew R. Weir, MDi and
- Faiez Zannad, MD, PhDa
- aUniversité de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique, Nancy, France
- bDepartment of Medicine, University of Mississippi, Jackson, Mississippi
- cDepartment of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
- dDepartment of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- eSaint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
- fThe George Institute for Global Health, and University of New South Wales, Sydney, New South Wales, Australia
- gDepartment of Medicine Solna, Unit of Cardiology, Karolinska Institute, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
- hAmerican Heart Association, Comprehensive Hypertension Center University of Chicago Medicine, Chicago, Illinois
- iDivision of Nephrology, Department of Medicine, University of Maryland, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. João Pedro Ferreira, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, 4 Rue du Morvan, 54500 Vandœuvre-Lès-Nancy, France.
• Potassium alterations may have life-threatening consequences.
• Hypokalemia is associated with adverse outcomes likely via causal mechanisms.
• Hyperkalemia leads to the stopping of renin angiotensin aldosterone system inhibitor that may have adverse consequences.
• Correction of both hypokalemia and hyperkalemia offsets their associated risk.
Potassium (K+) is the most abundant cation in humans and is essential for normal cellular function. Alterations in K+ regulation can lead to neuromuscular, gastrointestinal, and cardiac abnormalities. Dyskalemia (i.e., hypokalemia and hyperkalemia) in heart failure is common because of heart failure itself, related comorbidities, and medications. Dyskalemia has important prognostic implications. Hypokalemia is associated with excess morbidity and mortality in heart failure. The lower the K+ levels, the higher the risk, starting at K+ levels below approximately 4.0 mmol/l, with a steep risk increment with K+ levels <3.5 mmol/l. Hyperkalemia (>5.5 mmol/l) has also been associated with increased risk of adverse events; however, this association is prone to reverse-causation bias as stopping renin angiotensin aldosterone system inhibitor therapy in the advent of hyperkalemia likely contributes the observed risk. In this state-of-the-art review, practical and easy-to-implement strategies to deal with both hypokalemia and hyperkalemia are provided as well as guidance for the use of potassium-binders.
Dr. Butler has received personal fees from Abbott, Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, G3 Pharmaceutical, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Roche, Sanofi, SC Pharma, V-Wave Limited, and Vifor. Dr. Rossingnol has received personal fees from Idorsia, G3 Pharmaceutical, AstraZeneca, Bayer, Boehringer Ingelheim, CVRx, Fresenius, Grunethal, Novartis, NovoNordisk, Servier, Stealth Peptides, Ablative Solutions, Corvidia, Relypsa, and Vifor Fresenius Medical Care Renal Pharma; and is the cofounder of Cardiorenal. Dr. Pitt has received personal fees from Vifor/Relypsa, AstraZeneca, Bayer, and KBP Pharmaceuticals; has stock options with Relypsa and KBP Pharmaceuticals; and has U.S. patent 9931412 for site-specific delivery of eplerenone to the myocardium. Dr. Anker has received personal fees from Vifor, AstraZeneca, Boehringer Ingelheim, Novartis, and Servier; and has received grants from Vifor and Abbott Vascular. Dr. Kosiborod has received personal fees from Amarin, Amgen, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Eisai, Eli Lilly, GlaxoSmithKline, Glytec, Intarcia, Janssen, Merck (Diabetes), Novartis, NovoNordisk, Sanofi, and Vifor Pharma. Dr. Lund has received grants and personal fees from Relypsa, Vifor Pharma, and AstraZeneca. Dr. Bakris has received personal fees from Merck, Relypsa, and AstraZeneca; and is on steering committees with Bayer, NovoNordisk, and Vascular Dynamics. Dr. Weir has received personal fees from Vifor, Relypsa, AstraZeneca, Janssen, Boehringer Ingelheim, and Merck, Sharp & Dohme. Dr. Zannad has received personal fees from Amgen, Applied Therapeutics, AstraZeneca, Bayer, Boston Scientific, CVRx, Cereno, G3 Pharmaceutical, Janssen, MyoKardia, Novartis, and Vifor-Fresenius; is cofounder of Cardiorenal and CVCT; and holds equities at Cereno. Drs. Butler, Anker, Rossignol, Lund, Pitt, and Weir integrate the Executive Committee of the DIAMOND study (NCT03888066). Dr. Ferreira has reported that he has no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received March 9, 2020.
- Revision received March 31, 2020.
- Accepted April 2, 2020.
- 2020 American College of Cardiology Foundation
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