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28.10.2017 | Original Paper | Ausgabe 3/2018

Clinical Research in Cardiology 3/2018

Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications

Zeitschrift:
Clinical Research in Cardiology > Ausgabe 3/2018
Autoren:
Matthieu Legrand, Pierre-Olivier Ludes, Ziad Massy, Patrick Rossignol, Jiri Parenica, Jin-Joo Park, Shiro Ishihara, Khalid F. AlHabib, Aldo Maggioni, Òscar Miró, Naoki Sato, Alain Cohen-Solal, Enrique Fairman, Johan Lassus, Veli-Pekka Harjola, Christian Mueller, Franck W. Peacock, Dong-Ju Choi, Patrick Plaisance, Jindřich Spinar, Mikhail Kosiborod, Alexandre Mebazaa, Etienne Gayat, GREAT (Global Research on Acute Conditions Team) Network and INI-CRCT (Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists) network
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00392-017-1173-3) contains supplementary material, which is available to authorized users.
Miró Òscar: Member of the ICA-SEMES Research Group, Spain.
Mebazaa Alexandre and Gayat Etienne these authors contributed equally to the work.

Abstract

Background

The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown.

Methods

Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes.

Results

Positive and negative linear relationships between 90-day mortality and sK+ above 4.5 mmol/L (hyperkalemia) and below 3.5 mmol/L (hypo-kalemia) were observed. Hazard ratio for death was 1.46 [1.34–1.58] for hyperkalemia and 1.22 [1.06–1.40] for hypokalemia. In a fully adjusted model, only hyperkalemia remained associated with mortality (HR 1.03 [1.02–1.04] for each 0.1 mmol/l change of sK+ above 4.5 mmol/L). Interaction tests revealed that the association between hyperkalemia and outcome was significantly affected by chronic medications. The association between hyperkalemia and mortality was absent for patients treated with beta blockers and in those with preserved renal function.

Conclusions

In patients with AHF, sK+ > 4.5 mmol/L appears to be associated with 90-day mortality. B-blockers have potentially a protective effect in the setting of hyperkalemia.

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Zusatzmaterial
Supplemental Digital Content—Figure 1. Flowchart of patients included in the study. Potassium thresholds were obtained from analysis of the relationship between potassium level and outcome (see Figure 1). (GIF 12 KB)
392_2017_1173_MOESM1_ESM.gif
Literatur
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