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Incidence, Predictors, and Outcome Associations of Dyskalemia in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction
Karolinska Inst, Sweden.
Karolinska Inst, Sweden.
Karolinska Inst, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-6353-8041
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2019 (English)In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 7, no 1, p. 65-76Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES This study investigated 1-year incidence and predictors of dyskalemia (dysK) and its outcome associations in heart failure with preserved ejection fraction (HFpEF), HF with mid-range EF (HFmrEF), and HF with reduced EF (HFrEF). BACKGROUND DysK in real-world HF is insufficiently characterized. Fear of dyskalemia may lead to underuse or underdosing of renin-angiotensin-aldosterone system inhibitors. METHODS Patients enrolled in the SwedeHF (Swedish Heart Failure) Registry from 2006 to 2011 in Stockholm, Sweden were included in the analyses. Multivariate Cox regression analysis identified independent predictors of dysK within 1 year. Time-dependent Cox models assessed outcomes associated with incident dysK (all-cause death, HF, and other cardiovascular disease [CVD] hospitalizations) within 1 year from baseline. RESULTS Of 5,848 patients, 24.4% experienced hyperkalemia (hyperK [K amp;gt; 5.0 mmol/l]) at least once, and 10.2% had moderate or severe hyperK (K amp;gt; 5.5 mmol/l). Adjusted risk of moderate or severe hyperK was highest in HFpEF and HFmrEF. Similarly, 20.3% of patients had at least one episode of hypokalemia (hypoK [amp;lt;3.5 mmol/l]), and 3.7% had severe hypoK (amp;lt;3.0 mmol/l). Adjusted risk of any hypoK was highest in HFpEF. Independent predictors of both hyperK and hypoK were sex, baseline potassium and estimated glomerular filtration rate, low hemoglobin, chronic obstructive pulmonary disease (COPD), inpatient status, and higher New York Heart Association functional class. Incident dysK was associated with increased risk of mortality. Furthermore, hypoK was associated with increased CVD hospitalizations (HF-related excluded). There was no association between dysK and HF hospitalization risk, regardless of EF. CONCLUSIONS DysK is common in HF and is associated with increased mortality. Risk of moderate or severe hyperK was highest in HFpEF and HFmrEF, whereas risk of hypoK was highest in HFpEF. HF severity, low hemoglobin, COPD, baseline high and low potassium, and low eGFR were relevant predictors of dysK occurrence. (C) 2019 by the American College of Cardiology Foundation.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD , 2019. Vol. 7, no 1, p. 65-76
Keywords [en]
dyskalemia; heart failure; hyperkalemia; hypokalemia; mid-range ejection fraction; preserved ejection fraction; reduced ejection fraction; SCREAM; SwedeHF
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-153970DOI: 10.1016/j.jchf.2018.10.003ISI: 000454642900010PubMedID: 30553905OAI: oai:DiVA.org:liu-153970DiVA, id: diva2:1281541
Note

Funding Agencies|Vifor Fresenius Medical Care Renal Pharma and Relypsa; Swedish Heart and Lung Foundation [20120321, 20150557]; Swedish Research Council [2013-23897-104604-23, 523-2014-2336]; Stockholm County Council (ALF projects); AstraZeneca; Martin Rinds Foundation; Westmans Foundation; Relypsa; Vifor Pharma; Novartis; Sanofi; French National Research Agency public grant, second Investissements dAvenir program FIGHT-HF [ANR-15-RHU-0004]; French PIA project Lorraine Universite dExcellence grant [ANR-15-IDEX-04-LUE]; Merck and Co.; Boehringer Ingelheim

Available from: 2019-01-22 Created: 2019-01-22 Last updated: 2019-01-22

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Dahlström, Ulf
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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