Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEF
BackgroundThe frequency of hyperkalemia in patients with heart failure with reduced ejection fraction (HFrEF) receiving a high percentage of quadruple guideline-directed medical therapy (GDMT) has not been described extensively. The consequences of hyperkalemia on modifications in GDMT have not been...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-05-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1562647/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850144537596395520 |
|---|---|
| author | Genaro H. Mendoza-Zavala Gibran Reynoso-Hernandez Edith L. Posada-Martinez Miguel Sandoval-Jimenez Jairo I. A. Alejo-Arcos Kassandra Rios-Felix Eileen Amaro-Balderas Marisol Gomez-Lopez Sonia C. Juarez-Comboni Luis F. Tejado-Gallegos Emerson Joachin-Sanchez Luis Olmos-Dominguez Moises Aceves-Garcia Marco J. Olalde-Roman Marissa A. Silva-Garcia Eduardo Almeida-Gutierrez Cristina Revilla-Monsalve Adolfo Chavez-Mendoza Jose A. Cigarroa-Lopez Jonathan S. Chávez-Iñiguez Jose A. Magaña-Serrano Juan B. Ivey-Miranda |
| author_facet | Genaro H. Mendoza-Zavala Gibran Reynoso-Hernandez Edith L. Posada-Martinez Miguel Sandoval-Jimenez Jairo I. A. Alejo-Arcos Kassandra Rios-Felix Eileen Amaro-Balderas Marisol Gomez-Lopez Sonia C. Juarez-Comboni Luis F. Tejado-Gallegos Emerson Joachin-Sanchez Luis Olmos-Dominguez Moises Aceves-Garcia Marco J. Olalde-Roman Marissa A. Silva-Garcia Eduardo Almeida-Gutierrez Cristina Revilla-Monsalve Adolfo Chavez-Mendoza Jose A. Cigarroa-Lopez Jonathan S. Chávez-Iñiguez Jose A. Magaña-Serrano Juan B. Ivey-Miranda |
| author_sort | Genaro H. Mendoza-Zavala |
| collection | DOAJ |
| description | BackgroundThe frequency of hyperkalemia in patients with heart failure with reduced ejection fraction (HFrEF) receiving a high percentage of quadruple guideline-directed medical therapy (GDMT) has not been described extensively. The consequences of hyperkalemia on modifications in GDMT have not been fully addressed in patients receiving quadruple therapy.MethodsThis was a retrospective cohort study of outpatients with HFrEF treated at a specialized heart failure clinic. A case-by-case retrospective review of patients fulfilling the selection criteria was conducted by dedicated personnel. The main exposure was the occurrence of hyperkalemia at any visit, and the primary outcome was the modification in GDMT following hyperkalemia.ResultsWe included 1,279 medical encounters from 500 unique patients. Over a mean follow-up of 11 ± 7 months (2.6 ± 0.9 visits), the proportion of patients receiving angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, beta-blockers, spironolactone, sodium-glucose co-transporter 2 inhibitors (SGLT2is), and quadruple therapy increased to 98.6%, 99.0%, 97.4%, 93%, and 89.6%, respectively (P < 0.001 compared to baseline). The proportion of hyperkalemia during follow-up, defined as serum potassium >5.0,>5.5, and >6.0 mmol/L at any visit, was 44.4%, 13.0%, and 4.0%, respectively. In multivariable analysis, estimated glomerular filtration rate was the only independent predictor of hyperkalemia across all cutoff values (P < 0.001 for all). Serum potassium was associated with greater odds of mineralocorticoid receptor antagonist (MRA) discontinuation in a non-linear fashion, with an increased risk starting at >5.0 mmol/L (P < 0.001). Initiation of SGLT2is was not associated with lower odds of developing hyperkalemia at subsequent visits (P > 0.20 for all cutoff values).ConclusionsHyperkalemia >5.0 mmol/L is highly prevalent in patients with HFrEF receiving quadruple GDMT. Even with mild hyperkalemia, discontinuation of MRAs remains the primary strategy for managing this complication. |
| format | Article |
| id | doaj-art-c907bbaa89084136b2ccc91bd3d97a87 |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-c907bbaa89084136b2ccc91bd3d97a872025-08-20T02:28:19ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-05-011210.3389/fcvm.2025.15626471562647Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEFGenaro H. Mendoza-Zavala0Gibran Reynoso-Hernandez1Edith L. Posada-Martinez2Miguel Sandoval-Jimenez3Jairo I. A. Alejo-Arcos4Kassandra Rios-Felix5Eileen Amaro-Balderas6Marisol Gomez-Lopez7Sonia C. Juarez-Comboni8Luis F. Tejado-Gallegos9Emerson Joachin-Sanchez10Luis Olmos-Dominguez11Moises Aceves-Garcia12Marco J. Olalde-Roman13Marissa A. Silva-Garcia14Eduardo Almeida-Gutierrez15Cristina Revilla-Monsalve16Adolfo Chavez-Mendoza17Jose A. Cigarroa-Lopez18Jonathan S. Chávez-Iñiguez19Jose A. Magaña-Serrano20Juan B. Ivey-Miranda21Department of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Echocardiography, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoAstraZeneca, Mexico City, MexicoAstraZeneca, Mexico City, MexicoAstraZeneca, Mexico City, MexicoAstraZeneca, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Education and Research, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoUnidad de Investigacion Medica en Enfermedades Metabolicas, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Nephrology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoDepartment of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, MexicoBackgroundThe frequency of hyperkalemia in patients with heart failure with reduced ejection fraction (HFrEF) receiving a high percentage of quadruple guideline-directed medical therapy (GDMT) has not been described extensively. The consequences of hyperkalemia on modifications in GDMT have not been fully addressed in patients receiving quadruple therapy.MethodsThis was a retrospective cohort study of outpatients with HFrEF treated at a specialized heart failure clinic. A case-by-case retrospective review of patients fulfilling the selection criteria was conducted by dedicated personnel. The main exposure was the occurrence of hyperkalemia at any visit, and the primary outcome was the modification in GDMT following hyperkalemia.ResultsWe included 1,279 medical encounters from 500 unique patients. Over a mean follow-up of 11 ± 7 months (2.6 ± 0.9 visits), the proportion of patients receiving angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, beta-blockers, spironolactone, sodium-glucose co-transporter 2 inhibitors (SGLT2is), and quadruple therapy increased to 98.6%, 99.0%, 97.4%, 93%, and 89.6%, respectively (P < 0.001 compared to baseline). The proportion of hyperkalemia during follow-up, defined as serum potassium >5.0,>5.5, and >6.0 mmol/L at any visit, was 44.4%, 13.0%, and 4.0%, respectively. In multivariable analysis, estimated glomerular filtration rate was the only independent predictor of hyperkalemia across all cutoff values (P < 0.001 for all). Serum potassium was associated with greater odds of mineralocorticoid receptor antagonist (MRA) discontinuation in a non-linear fashion, with an increased risk starting at >5.0 mmol/L (P < 0.001). Initiation of SGLT2is was not associated with lower odds of developing hyperkalemia at subsequent visits (P > 0.20 for all cutoff values).ConclusionsHyperkalemia >5.0 mmol/L is highly prevalent in patients with HFrEF receiving quadruple GDMT. Even with mild hyperkalemia, discontinuation of MRAs remains the primary strategy for managing this complication.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1562647/fullheart failureGDMThyperkalemiaspironolactonepotassium binders |
| spellingShingle | Genaro H. Mendoza-Zavala Gibran Reynoso-Hernandez Edith L. Posada-Martinez Miguel Sandoval-Jimenez Jairo I. A. Alejo-Arcos Kassandra Rios-Felix Eileen Amaro-Balderas Marisol Gomez-Lopez Sonia C. Juarez-Comboni Luis F. Tejado-Gallegos Emerson Joachin-Sanchez Luis Olmos-Dominguez Moises Aceves-Garcia Marco J. Olalde-Roman Marissa A. Silva-Garcia Eduardo Almeida-Gutierrez Cristina Revilla-Monsalve Adolfo Chavez-Mendoza Jose A. Cigarroa-Lopez Jonathan S. Chávez-Iñiguez Jose A. Magaña-Serrano Juan B. Ivey-Miranda Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEF Frontiers in Cardiovascular Medicine heart failure GDMT hyperkalemia spironolactone potassium binders |
| title | Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEF |
| title_full | Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEF |
| title_fullStr | Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEF |
| title_full_unstemmed | Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEF |
| title_short | Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEF |
| title_sort | frequency of hyperkalemia during optimization of guideline directed medical therapy in ambulatory patients with hfref |
| topic | heart failure GDMT hyperkalemia spironolactone potassium binders |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1562647/full |
| work_keys_str_mv | AT genarohmendozazavala frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT gibranreynosohernandez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT edithlposadamartinez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT miguelsandovaljimenez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT jairoiaalejoarcos frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT kassandrariosfelix frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT eileenamarobalderas frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT marisolgomezlopez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT soniacjuarezcomboni frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT luisftejadogallegos frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT emersonjoachinsanchez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT luisolmosdominguez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT moisesacevesgarcia frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT marcojolalderoman frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT marissaasilvagarcia frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT eduardoalmeidagutierrez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT cristinarevillamonsalve frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT adolfochavezmendoza frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT joseacigarroalopez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT jonathanschaveziniguez frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT joseamaganaserrano frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref AT juanbiveymiranda frequencyofhyperkalemiaduringoptimizationofguidelinedirectedmedicaltherapyinambulatorypatientswithhfref |