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Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications

Legrand, Matthieu
Author Legrand, Matthieu ORCID Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique- Hôpitaux de Paris,, Paris, France. matthieu.legrand@aphp.fr AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France. matthieu.legrand@aphp.fr Université Paris Diderot, Sorbonne Paris Cité, Paris, France. matthieu.legrand@aphp.fr UMR 942, INSERM, Paris, France. matthieu.legrand@aphp.fr
Ludes, Pierre-Olivier
Author Ludes, Pierre-Olivier Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique- Hôpitaux de Paris,, Paris, France AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
Massy, Ziad
Author Massy, Ziad Division of Nephrology, Ambroise Paré university hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt, Paris, France INSERM U1018 Team5, Research Centre in Epidemiology and Population Health (CESP), Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
Rossignol, Patrick
Author Rossignol, Patrick INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
Parenica, Jiri
Author Parenica, Jiri Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic Faculty of Medicine, Masaryk University, Brno, Czech Republic
Park, Jin-Joo
Author Park, Jin-Joo Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, South Korea
Ishihara, Shiro
Author Ishihara, Shiro Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
AlHabib, Khalid F
Author AlHabib, Khalid F Department of Cardiac Sciences, College of Medicine, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
Maggioni, Aldo
Author Maggioni, Aldo ANMCO Research Center, Firenze, Italy
Miró, Òscar
Author Miró, Òscar Emergency Department, Hospital Clinic, and 'Emergency care: processes and diseases' Research Group, IDIBAPS, Barcelona, Catalonia, Spain
Sato, Naoki
Author Sato, Naoki Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
Cohen-Solal, Alain
Author Cohen-Solal, Alain Department of Cardiology, Hôpitaux Universitaire Saint Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France
Fairman, Enrique
Author Fairman, Enrique Sociedad Argentina de Cardiologia, Area de Investigacion SAC Azcuenaga, Buenos Aires, Argentina
Lassus, Johan
Author Lassus, Johan Cardiology, Helsinki University and Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
Harjola, Veli-Pekka
Author Harjola, Veli-Pekka Cardiology, Helsinki University and Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland
Mueller, Christian
Author Mueller, Christian Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland
Peacock, Franck W
Author Peacock, Franck W Baylor College of Medicine, Houston, TX,, USA
Choi, Dong-Ju
Author Choi, Dong-Ju Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, South Korea
Plaisance, Patrick
Author Plaisance, Patrick Emergency Department, Hôpitaux Universitaire Saint Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France
Spinar, Jindřich
Author Spinar, Jindřich Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic Faculty of Medicine, Masaryk University, Brno, Czech Republic
Kosiborod, Mikhail
Author Kosiborod, Mikhail Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas, MO, USA
Mebazaa, Alexandre
Author Mebazaa, Alexandre Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique- Hôpitaux de Paris,, Paris, France AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France Université Paris Diderot, Sorbonne Paris Cité, Paris, France UMR 942, INSERM, Paris, France
Gayat, Etienne
Author Gayat, Etienne Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique- Hôpitaux de Paris,, Paris, France AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France Université Paris Diderot, Sorbonne Paris Cité, Paris, France UMR 942, INSERM, Paris, France
GREAT (Global Research on Acute Conditions Team) Network and INI-CRCT (Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists) network
Author GREAT (Global Research on Acute Conditions Team) Network and INI-CRCT (Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists) network

Clinical research in cardiology. 2018 Mar ; 107 (3) : 214-221. [epub] 20171028

Clin Res Cardiol
ISSN 1861-0692 | 1861-0684
Source

Language English Country Germany Media print-electronic

Document type Journal Article, Multicenter Study, Observational Study

Persistent link https://www.medvik.cz/link/pmid29080909

PubMed 29080909
DOI 10.1007/s00392-017-1173-3
PII: 10.1007/s00392-017-1173-3
Knihovny.cz E-resources

Keywords
B-blockers, Heart failure, Mortality, Potassium, Renal failure,
MeSH
Acute Disease MeSH
Adrenergic beta-Antagonists therapeutic use MeSH
Biomarkers blood MeSH
Time Factors MeSH
Potassium blood MeSH
Hyperkalemia etiology mortality prevention & control MeSH
Hypokalemia etiology mortality prevention & control MeSH
Middle Aged MeSH
Humans MeSH
Survival Rate trends MeSH
Follow-Up Studies MeSH
Prospective Studies MeSH
Aged, 80 and over MeSH
Aged MeSH
Heart Failure blood complications drug therapy MeSH
Treatment Outcome MeSH
Check Tag
Middle Aged MeSH
Humans MeSH
Male MeSH
Aged, 80 and over MeSH
Aged MeSH
Female MeSH
Publication type
Journal Article MeSH
Multicenter Study MeSH
Observational Study MeSH
Geographicals
Europe epidemiology MeSH
United States epidemiology MeSH
Names of Substances
Adrenergic beta-Antagonists MeSH
Biomarkers MeSH
Potassium MeSH

BACKGROUND: The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown. METHODS: Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes. RESULTS: Positive and negative linear relationships between 90-day mortality and sK+ above 4.5 mmol/L (hyperkalemia) and below 3.5 mmol/L (hypo-kalemia) were observed. Hazard ratio for death was 1.46 [1.34-1.58] for hyperkalemia and 1.22 [1.06-1.40] for hypokalemia. In a fully adjusted model, only hyperkalemia remained associated with mortality (HR 1.03 [1.02-1.04] for each 0.1 mmol/l change of sK+ above 4.5 mmol/L). Interaction tests revealed that the association between hyperkalemia and outcome was significantly affected by chronic medications. The association between hyperkalemia and mortality was absent for patients treated with beta blockers and in those with preserved renal function. CONCLUSIONS: In patients with AHF, sK+ > 4.5 mmol/L appears to be associated with 90-day mortality. B-blockers have potentially a protective effect in the setting of hyperkalemia.

ANMCO Research Center Firenze Italy

AP HP Groupe Hospitalier Saint Louis Lariboisière Fernand Widal Paris France

Baylor College of Medicine Houston TX USA

Cardiology Helsinki University and Helsinki University Hospital Heart and Lung Center Helsinki Finland

Department of Anesthesiology and Critical Care and Burn Unit St Louis Hospital Assistance Publique Hôpitaux de Paris Paris France

Department of Cardiac Sciences College of Medicine King Fahad Cardiac Center King Saud University Riyadh Saudi Arabia

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Switzerland

Department of Cardiology Hôpitaux Universitaire Saint Louis Lariboisière Assistance Publique des Hôpitaux de Paris Paris France

Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic

Division of Cardiology Department of Internal Medicine Cardiovascular Center Seoul National University Bundang Hospital Seoul South Korea

Division of Nephrology Ambroise Paré university hospital APHP University of Paris Ouest Versailles St Quentin en Yvelines Boulogne Billancourt Paris France

Emergency Department Hôpitaux Universitaire Saint Louis Lariboisière Assistance Publique des Hôpitaux de Paris Paris France