Hipercaliemia e otimização dos inibidores do sistema renina-angiotensina-aldosterona na insuficiência cardíaca crónica com disfunção sistólica: uma revisão sistemática

Translated title of the contribution: Hyperkalemia and management of renin-angiotensin-aldosterone system inhibitors in chronic heart failure with reduced ejection fraction: A systematic review

Cândida Fonseca, Dulce Brito, Patrícia Branco, João Miguel Frazão, José Silva-Cardoso, Paulo Bettencourt

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)

Abstract

Introduction and Objectives: Renin-angiotensin-aldosterone system inhibitors (RAASi) are the cornerstone of treatment of heart failure with reduced ejection fraction (HFrEF). RAASi optimization in real-life care is challenged by hyperkalemia, a potentially fatal adverse event, which can necessitate downtitration or discontinuation of RAASi and negatively impact survival in HFrEF. The literature on this problem is sparse. We performed a systematic review of studies on HFrEF to investigate the prevalence, incidence, and risk factors of hyperkalemia, RAASi prescription rates, frequency of RAASi downtitration or discontinuation due to hyperkalemia, and the potential negative effect of the latter on prognosis. Methods: We conducted a MEDLINE (PubMed) search including observational and interventional studies published between January 1987 and May 2018. Results: A total of 30 observational and 18 interventional studies were included in the review. The incidence of hyperkalemia reported was between 0% and 63% in observational studies and was between 0% and 30% in clinical trials. Risk factors for hyperkalemia included RAASi prescription, older age, diabetes, and chronic kidney disease. In real-life studies, RAASi were downtitrated or discontinued in 3-22% of HFrEF patients; hyperkalemia was the reported cause in 5% of cases. No reports were found on the impact on prognosis of RAASi downtitration or discontinuation due to hyperkalemia. Conclusions: Hyperkalemia and RAASi downtitration or discontinuation are frequent, particularly in real-life HFrEF studies. Further research is needed to clarify the role of RAASi downtitration or discontinuation due to hyperkalemia and to assess its long-term prognostic impact in HFrEF patients.

Translated title of the contributionHyperkalemia and management of renin-angiotensin-aldosterone system inhibitors in chronic heart failure with reduced ejection fraction: A systematic review
Original languagePortuguese
Pages (from-to)517-541
JournalRevista Portuguesa de Cardiologia
Volume39
Issue number9
DOIs
Publication statusPublished - Sep 2020

Keywords

  • Clinical decision-making
  • Clinical outcomes
  • Drug therapy
  • Heart failure
  • Hyperkalemia
  • Renin-angiotensin-aldosterone system inhibitors

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