A propensity-matched study of the association of low serum potassium levels and mortality in chronic heart failure

Ahmed, Ali; Zannad, Faı̈ez; Love, Thomas E.; Tallaj, José; Gheorghiade, Mihai; Ekundayo, O. James; Pitt, Bertram

doi:10.1093/eurheartj/ehm091

Cited by 164 publications

(169 citation statements)

References 50 publications

(69 reference statements)

Supporting

Mentioning

148

Contrasting

Unclassified

Order By: Relevance

“…This result is concordant with a previous study where the risk of hypokalemia was significantly reduced among patients receiving MRAs [3]. Reducing the risk of hypokalemia is a significant issue due to the fact that a potassium level below 4.0 mmol/L has been associated with an increased risk of death from any cause among patients with systolic heart failure [21]. Moreover, worsening renal function occurred more frequently in control group.…”

Section: Discussionsupporting

confidence: 91%

Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure

Ferreira

Santos

Almeida

et al. 2014

European Journal of Internal Medicine

View full text Add to dashboard Cite

Background/objectives: Mineralocorticoid receptor antagonist (MRA) use in acutely decompensated chronic heart failure (ADCHF) may improve congestion through diuretic effect and prevent neurohormonal activation. We aimed to evaluate the clinical effect and safety of spironolactone in ADCHF. Methods: Prospective, experimental, single-center, and single-blinded trial. Patients were treated with: standard ADCHF therapy or oral spironolactone 50-100 mg/d plus standard ADCHF therapy. Results: During a 1 year period, 100 patients were enrolled, 50 included in the treatment group. Mean (SD) spironolactone dose (mg) at day 1 was 94.5 ± 23.3 and at day 3 was 62.7 ± 24.3. Worsening renal function (increase in pCr ≥ 0.3 mg/dL from day 1 to day 3) was more likely to occur in control group (20% vs. 4%; p = 0.038), serum potassium did not differ between groups, and plasma NTproBNP had a significant decrease in spironolactone group at day 3 (median [IQR], 2488[IQR], [4579] vs. 1555[IQR], [1832; p = 0.05). Furthermore, a greater proportion of patients in the treatment group were free of congestion at day 3: less edema, rales, jugular venous pressure (JVP) and orthopnea (all, p b 0.05). In addition, a significantly higher proportion of patients were on oral furosemide at day 3 (44% vs. 82%; p b 0.001). Conclusions: Our study supports the safety of high dose spironolactone in ADCHF and suggests a positive impact in the resolution of congestion. The important findings of our pilot study need to be confirmed in larger trials.

show abstract

Section: Discussionsupporting

confidence: 91%

Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure

Ferreira

Santos

Almeida

et al. 2014

European Journal of Internal Medicine

View full text Add to dashboard Cite

show abstract

“…Dietary potassium depletion has been linked to the genesis of hypertension, and supplementation can improve BP control (17)(18)(19). Data from the cardiovascular literature suggest that serum potassium levels Ͻ4.0 mmol/L portend a worse prognosis among those who have a history of heart failure or acute myocardial infarction (20,21). Current American Heart Association/American College of Cardiology guidelines recommend that serum potassium levels be maintained between 4.0 and 5.0 mmol/L in those with chronic heart failure (22).…”

Section: Discussionmentioning

confidence: 99%

Serum Potassium and Outcomes in CKD

Korgaonkar¹,

Tilea²,

Gillespie³

et al. 2010

Clinical Journal of the American Society of Nephrology

195

156

View full text Add to dashboard Cite

Background and objectives:The relationship between serum potassium (S K ) and mortality in chronic kidney disease (CKD) has not been systematically investigated.Design, setting, participants, & measurements: We examined the predictors and mortality association of S K in the Renal Research Institute CKD Study cohort, wherein 820 patients with CKD were prospectively followed at four US centers for an average of 2.6 years. Predictors of S K were investigated using linear and repeated measures regression models. Associations between S K and mortality, the outcomes of ESRD, and cardiovascular events in time-dependent Cox models were examined.Results: The mean age was 60.5 years, 80% were white, 90% had hypertension, 36% had diabetes, the average estimated GFR was 25.4 ml/min per 1.73 m 2 , and mean baseline S K was 4.6 mmol/L. Higher S K was associated with male gender, lower estimated GFR and serum bicarbonate, absence of diuretic and calcium channel blocker use, diabetes, and use of angiotensinconverting enzyme inhibitors and/or statins. A U-shaped relationship between S K and mortality was observed, with mortality risk significantly greater at S K <4.0 mmol/L compared with 4.0 to 5.5 mmol/L. Risk for ESRD was elevated at S K <4 mmol/L in S K categorical models. Only the composite of cardiovascular events or death as an outcome was associated with higher S K (>5.5).Conclusions: Although clinical practice usually emphasizes greater attention to elevated S K in the setting of CKD, our results suggest that patients who have CKD and low or even low-normal S K are at higher risk for dying than those with mild to moderate hyperkalemia.

show abstract

“…[14][15][16][17] In this study, the PS was the conditional probability for getting ACE inhibitors, as a binary-dependent variable, under a set of measurements. Clinical risk factors, such as sex, age, hypertension, diabetes, left ventricular mass, medication use, coronary artery disease, blood creatinine levels, the number of diseased coronary arteries, previous myocardial infarction, hemoglobin levels, dyslipidemia, severity of valvular heart disease, genetic polymorphisms, and medication history in addition to ACE inhibitors were added into a nonparsimonious multivariable logistic regression model to predict the predilection for the use of ACE inhibitors.…”

Section: Ps-based Matchingmentioning

confidence: 99%

Demonstrating the pharmacogenetic effects of angiotensin-converting enzyme inhibitors on long-term prognosis of diastolic heart failure

Jl²,

Tsai

et al. 2009

Pharmacogenomics J

View full text Add to dashboard Cite

The objective of this study was to evaluate the effects of angiotensin-converting enzyme (ACE) inhibitors and pharmacogenetic interaction on the survival of the patients with diastolic heart failure (DHF). A total of 285 subjects with DHF confirmed by echocardiography were recruited in the period between 1995 and 2003. Baseline characteristics (age, sex, prior history, medication, and echocardiographic findings) and genetic polymorphisms (ACE gene insertion/ deletion (I/D) polymorphism; T174M, M235T, G-6A, A-20C, G-152A, and G-217A polymorphisms of the angiotensinogen (AGT) gene; and A1166C polymorphisms of the angiotensin II type I receptor (AT1R)) were collected and matched (by propensity score) in those who received and those who did not receive ACE inhibitors. The patients were followed up to 10 years. Kaplan-Meier curves and Cox regression models were used to demonstrate the survival trend. The 85 patients who received ACE inhibitors and the other 85 patients who did not were found to have comparable baseline characteristics and polymorphism distribution. Prescription of ACE inhibitors was associated with a significant decrease in overall mortality (hazard ratio (HR), 0.45; 95% confidence interval (CI), 0.24-0.83; P ¼ 0.01), and a lower rate of cardiovascular events at 4000 days (HR, 0.53; 95% CI, 0.32-0.90; P ¼ 0.02). In addition, ACE I/D gene D allele was associated with higher overall mortality as compared with the I allele (HR, 2.04; P ¼ 0.003). This effect was diminished in those who received ACE inhibitors. The use of ACE inhibitor was associated with a significant decrease in long-term mortality and cardiovascular events in the patients with DHF. Genetic variants in the renin-angiotensin system genes were also associated, but their effects could be modified by the use of ACE inhibitors.

show abstract

A propensity-matched study of the association of low serum potassium levels and mortality in chronic heart failure

Abstract: In a cohort of ambulatory chronic systolic and diastolic HF patients who were balanced in all measured baseline covariates, serum potassium <4 mEq/L was associated with increased mortality, with a trend towards increased hospitalization.

Cited by 164 publications

References 50 publications

Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure

Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure

Serum Potassium and Outcomes in CKD

Demonstrating the pharmacogenetic effects of angiotensin-converting enzyme inhibitors on long-term prognosis of diastolic heart failure

Contact Info

Product

Resources

About