Targeted potassium levels to decrease arrhythmia burden in high risk patients with cardiovascular diseases (POTCAST): Study protocol for a randomized controlled trial

Winsløw, Ulrik; Sakthivel, Tharsika; Zheng, Chao; Bosselmann, Helle; Haugan, Ketil; Bruun, Niels Eske; Larroudé, Charlotte Ellen; Iversen, Kasper; Saffi, Hillah; Frandsen, E; Risum, Niels; Bundgaard, Henning; Jøns, Christian

doi:10.1016/j.ahj.2022.07.003

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…We observed a numerical increase in p-K of 0.16 mmol/l at the six months follow-up. This is consistent with increases in p-K of 0.16 to 0.30 mmol/l in patients with heart failure treated with MRA and with p-K increases of 0.09-0.19 mmol/l in patients with hypertension treated with potassium supplements [19].…”

Section: Plos Onesupporting

confidence: 84%

“…This single-center study was conducted between January and December 2021 as a substudy to the POTCAST trial at the Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Details, background and design of the ongoing POTCAST trial have been published previously [ 19 ]. The purpose of the POTCAST trial is to investigate if high-normal potassium level reduces the incidence of malignant tachyarrhythmias and death.…”

Section: Methodsmentioning

confidence: 99%

“…Between baseline and the six-week follow-up, the intervention group was given guidance on intake of a potassium rich diets along with potassium supplements and MRA (spironolactone or eplerenone) with the aim to increase and maintain p-K at target levels between 4.5-5.0 PLOS ONE mmol/l according to the design of the POTCAST trial [19]. Patients were uptitrated until target p-K was reached or until maximally tolerated doses of potassium supplement (up to 4,500 mg ~60 mmol daily) and MRA (up to 100 mg daily) were given.…”

Section: Interventionmentioning

confidence: 99%

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Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy

et al. 2023

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Objective Hypokalemia is associated with increased risk of arrhythmias and it is recommended to monitor plasma potassium (p-K) regularly in at-risk patients with cardiovascular diseases. It is poorly understood if administration of potassium supplements and mineralocorticoid receptor antagonists (MRA) aimed at increasing p-K also increases intracellular potassium. Methods Adults aged≥18 years with an implantable cardioverter defibrillator (ICD) were randomized (1:1) to a control group or to an intervention that included guidance on potassium rich diets, potassium supplements, and MRA to increase p-K to target levels of 4.5–5.0 mmol/l for six months. Total-body-potassium (TBK) was measured by a Whole-Body-Counter along with p-K at baseline, after six weeks, and after six months. Results Fourteen patients (mean age: 59 years (standard deviation 14), 79% men) were included. Mean p-K was 3.8 mmol/l (0.2), and mean TBK was 1.50 g/kg (0.20) at baseline. After six-weeks, p-K had increased by 0.47 mmol/l (95%CI:0.14;0.81), p = 0.008 in the intervention group compared to controls, whereas no significant difference was found in TBK (44 mg/kg (-20;108), p = 0.17). After six-months, no significant difference was found in p-K as compared to baseline (0.16 mmol/l (-0.18;0.51), p = 0.36), but a significant increase in TBK of 82 mg/kg (16;148), p = 0.017 was found in the intervention group compared to controls. Conclusions Increased potassium intake and MRAs increased TBK gradually and a significant increase was seen after six months. The differentially regulated p-K and TBK challenges current knowledge on potassium homeostasis and the time required before the full potential of p-K increasing treatment can be anticipated. Trial registration www.clinicaltrials.gov (NCT03833089).

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Section: Plos Onesupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy

et al. 2023

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“…Vital signs comprised heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and percutaneous oxygen saturation (SpO2). Laboratory tests covered hemoglobin, platelet count, white blood cell (WBC) count, sodium (Na), creatinine (Cr), and blood urea nitrogen 21 . Comorbidities recorded encompassed myocardial infarct, congestive heart failure, peripheral vascular disease, cerebrovascular disease, liver disease, kidney disease, malignant cancer, sepsis, diabetes, and hypertension.…”

Section: Methodsmentioning

confidence: 99%

Association between glycemic variability and short-term mortality in patients with acute kidney injury: a retrospective cohort study of the MIMIC-IV database

Guo,

Qiu,

Xue

et al. 2024

Sci Rep

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Acute kidney injury (AKI) represents a significant challenge to global public health problem and is associated with poor outcomes. There is still considerable debate about the effect of mean blood glucose (MBG) and coefficient of variation (CV) of blood glucose on the short-term mortality of AKI patients. This retrospective cohort study aimed to explore the association between glycemic variability and short-term mortality in patients with AKI. Data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were analyzed, including 6,777 adult AKI patients. MBG and CV on the first day of ICU admission were calculated to represent the overall glycemic status and variability during the ICU stay in AKI patients. The primary outcome indicator was ICU 30-day mortality of AKI patients. Multivariate Cox regression analysis and smoothed curve fitting were used to assess the relationship between blood glucose levels and mortality. Eventually, the ICU 30-day mortality rate of AKI patients was 23.5%. The increased MBG and CV were significantly correlated with ICU 30-day mortality (hazards ratio (HR) = 1.20, 95% confidence interval (CI) 1.14–1.27; HR = 1.08, 95% CI 1.03–1.13). The smoothed curve fitting showed a U-shaped relationship between MBG on the first day of ICU admission and ICU 30-day mortality (inflection point = 111.3 mg/dl), while CV had a linear relationship with 30-day ICU mortality. Thus, we conclude that MBG and CV were significantly associated with short-term mortality in intensive care patients with AKI. Tighter glycemic control may be an effective measure to improve the prognosis of patients with AKI.

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The effect of increased plasma potassium on myocardial function; a randomized POTCAST substudy

Winsløw

Sakthivel

Zheng

et al. 2023

Int J Cardiovasc Imaging

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Plasma potassium (p-K) in the high-normal range has been suggested to reduce risk of cardiovascular arrythmias and mortality through electrophysiological and mechanical effects on the myocardium. In this study, it was to investigated if increasing p-K to high-normal levels improves systolic- and diastolic myocardial function in patients with low-normal to moderately reduced left ventricular ejection fraction (LVEF). The study included 50 patients (mean age 58 years (SD 14), 81% men), with a mean p-K 3.95 mmol/l (SD 0.19), mean LVEF 48% (SD 7), and mean Global Longitudinal Strain (GLS) -14.6% (SD 3.1) patients with LVEF 35–55% from “Targeted potassium levels to decrease arrhythmia burden in high-risk patients with cardiovascular diseases trial” (POTCAST). Patients were given standard therapy and randomized (1:1) to an intervention that included guidance on potassium-rich diets, potassium supplements, and mineralocorticoid receptor antagonists targeting high-normal p-K levels (4.5-5.0 mmol/l). Echocardiography was done at baseline and after a mean follow-up of 44 days (SD 18) and the echocardiograms were analyzed for changes in GLS, mechanical dispersion, E/A, e’, and E/e’. At follow-up, mean difference in changes in p-K was 0.52 mmol/l (95%CI 0.35;0.69), P<0.001 in the intervention group compared to controls. GLS was improved with a mean difference in changes of -1.0% (-2;-0.02), P<0.05 and e’ and E/e’ were improved with a mean difference in changes of 0.9 cm/s (0.02;1.7), P = 0.04 and ? 1.5 (-2.9;-0.14), P = 0.03, respectively. Thus, induced increase in p-K to the high-normal range improved indices of systolic and diastolic function in patients with low-normal to moderately reduced LVEF.

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Targeted potassium levels to decrease arrhythmia burden in high risk patients with cardiovascular diseases (POTCAST): Study protocol for a randomized controlled trial

Cited by 3 publications

References 26 publications

Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy

Treatment-induced increase in total body potassium in patients at high risk of ventricular arrhythmias; a randomized POTCAST substudy

Association between glycemic variability and short-term mortality in patients with acute kidney injury: a retrospective cohort study of the MIMIC-IV database

The effect of increased plasma potassium on myocardial function; a randomized POTCAST substudy

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