New approaches to hyperkalemia in patients with indications for renin angiotensin aldosterone inhibitors: Considerations for trial design and regulatory approval

Zannad, Faı̈ez; Rossignol, Patrick; Stough, Wendy Gattis; Epstein, Murray; Garcia, Maria de los Angeles Alonso; Bakris, George L.; Butler, Javed; Kosiborod, Mikhail; Berman, Lance; Mebazaa, Alexandre; Rasmussen, Henrik; Ruilope, Luís M.; Stockbridge, Norman; Thompson, Aliza; Wittes, Janet; Pitt, Bertram

doi:10.1016/j.ijcard.2016.04.127

Cited by 22 publications

(27 citation statements)

References 38 publications

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“…Hyperkalaemia can develop as a result of increased K + intake, decreased K + excretion, an imbalance in K + re‐distribution or a combination thereof . People with certain chronic diseases like chronic kidney disease (CKD), heart failure (HF), hypertension (HT) or diabetes mellitus (DM) are at a particularly high risk of developing hyperkalaemia . Decreased kidney function contributes to hyperkalaemia as the kidney is the main route of K + excretion.…”

Section: Introductionmentioning

confidence: 99%

“…Decreased kidney function contributes to hyperkalaemia as the kidney is the main route of K + excretion. In addition, guideline‐recommended medications used to treat CKD, HF and HT, such as renin‐angiotensin‐aldosterone system inhibitors (RAASi) or K + ‐sparing diuretics like mineralocorticoid receptor antagonists (MRAs) are known to increase the likelihood of hyperkalaemia . Thus, many patients with these conditions require long‐term monitoring and management in order to remain normokalaemic …”

Section: Introductionmentioning

confidence: 99%

“…For patients in whom SPS/CPS would not be clinically recommended, only non‐pharmacological measures are currently available. These include reduction of K + intake by an appropriately controlled low‐K + diet, or discontinuation or dose‐reduction of key guideline‐recommended treatments such as RAASi and MRAs . Although dose‐reduction or discontinuation of RAASi or MRAs can attenuate hyperkalaemia, it leaves patients vulnerable to the poor cardio‐renal outcomes from conditions for which these treatments were prescribed, such as HF, HT, DM or CKD .…”

Section: Introductionmentioning

confidence: 99%

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Evidence in support of hyperkalaemia management strategies: A systematic literature review

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence in support of hyperkalaemia management strategies: A systematic literature review

et al. 2018

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“…The recent development of new potassium binders will contribute to facilitating the long-term maintenance of RAAS blockers, in particular mineralocorticoid receptor antagonists, while maintaining adequate serum potassium levels 14, 15 .…”

Section: Hypertension As a Mediator Of The Correlation Between Chronimentioning

confidence: 99%

“…Actually, two seminal studies are ongoing to test the capacity of the new MRA finerenone to slow down the progression of diabetic nephropathy (NCT02540993) 37 and to protect the CV system in type 2 diabetic patients (NCT02545049) 38 . The use of the new potassium binder patiromer and the selective cation exchanger sodium zirconium cyclosilicate 15 will contribute to the facilitation of MRA use in patients with CKD.…”

Section: Blockade Of Aldosterone: An Unfulfilled Promise?mentioning

confidence: 99%

The impact of antihypertensives on kidney disease

Márquez¹,

Ruiz‐Hurtado

Ruilope

2017

F1000Res

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Arterial hypertension and chronic kidney disease (CKD) are intimately related. The control of blood pressure (BP) levels is strongly recommended in patients with CKD in order to protect the kidney against the accompanying elevation in global cardiovascular (CV) risk. Actually, the goal BP in patients with CKD involves attaining values <140/90 mmHg except if albuminuria is present. In this case, it is often recommended to attain values <130/80 mmHg, although some guidelines still recommend <140/90 mmHg. Strict BP control to values of systolic BP around 120 mmHg was recently shown to be safe in CKD according to data from the SPRINT trial, albeit more data confirming this benefit are required. Usually, combination therapy initiated with an angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEi) and commonly followed by the addition of a calcium channel blocker and a diuretic is needed. Further studies are required as well as new drugs in particular after the positive data obtained from new oral anti-diabetic drugs.

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Prognostic significance of serum potassium in patients hospitalized for acute heart failure

et al. 2022

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AimWe investigated the prognostic significance of serum potassium abnormalities at discharge in patients hospitalized for acute heart failure (AHF). Methods and resultsIn a retrospective analysis, we included 926 patients hospitalized for AHF, stratified by serum potassium levels at discharge as hypokalaemia (<3.5 mEq/L), normokalaemia (3.5-5.0 mEq/L), and hyperkalaemia (>5.0 mEq/L). The primary endpoint was all-cause death at 1 year since hospital discharge. At discharge, 40 patients had hypokalaemia (4.3%), 840 normokalaemia (90.7%), and 46 hyperkalaemia (5.0%). Patients with hyperkalaemia at discharge were more frequently men, had more signs of congestion, and lower LVEF while patients with hypokalaemia were more likely to be women with HFpEF. Treatment with ACEi/ARBs and MRAs ≥50% of target dose at discharge was similar across groups. One year all-cause death occurred in 10% of the patients with hypokalaemia, 13.9% of those with normokalaemia, and 30.4% of those with hyperkalaemia (P = 0.006). After adjustment for covariates, including renal function, background treatment, and baseline potassium level, hyperkalaemia resulted an independent predictor of the primary endpoint (HR 1.96, 95% IC [1.01-3.82]; P = 0.048). Conclusions In patients with AHF, the presence of hyperkalaemia at discharge is an independent predictor of 1 year all-cause death.

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New approaches to hyperkalemia in patients with indications for renin angiotensin aldosterone inhibitors: Considerations for trial design and regulatory approval

Cited by 22 publications

References 38 publications

Evidence in support of hyperkalaemia management strategies: A systematic literature review

Evidence in support of hyperkalaemia management strategies: A systematic literature review

The impact of antihypertensives on kidney disease

Prognostic significance of serum potassium in patients hospitalized for acute heart failure

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