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Yap DYH, Ma RCW, Wong ECK, Tsui MSH, Yu EYT, Yu V, Szeto CC, Pang WF, Tse HF, Siu DCW, Tan KCB, Chen WWC, Li CL, Chen W, Chan TM. Consensus statement on the management of hyperkalaemia-An Asia-Pacific perspective. Nephrology (Carlton) 2024; 29:311-324. [PMID: 38403867 DOI: 10.1111/nep.14281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Hyperkalaemia is an electrolyte imbalance that impairs muscle function and myocardial excitability, and can potentially lead to fatal arrhythmias and sudden cardiac death. The prevalence of hyperkalaemia is estimated to be 6%-7% worldwide and 7%-10% in Asia. Hyperkalaemia frequently affects patients with chronic kidney disease, heart failure, and diabetes mellitus, particularly those receiving treatment with renin-angiotensin-aldosterone system (RAAS) inhibitors. Both hyperkalaemia and interruption of RAAS inhibitor therapy are associated with increased risks for cardiovascular events, hospitalisations, and death, highlighting a clinical dilemma in high-risk patients. Conventional potassium-binding resins are widely used for the treatment of hyperkalaemia; however, caveats such as the unpalatable taste and the risk of gastrointestinal side effects limit their chronic use. Recent evidence suggests that, with a rapid onset of action and improved gastrointestinal tolerability, novel oral potassium binders (e.g., patiromer and sodium zirconium cyclosilicate) are alternative treatment options for both acute and chronic hyperkalaemia. To optimise the care for patients with hyperkalaemia in the Asia-Pacific region, a multidisciplinary expert panel was convened to review published literature, share clinical experiences, and ultimately formulate 25 consensus statements, covering three clinical areas: (i) risk factors of hyperkalaemia and risk stratification in susceptible patients; (ii) prevention of hyperkalaemia for at-risk individuals; and (iii) correction of hyperkalaemia for at-risk individuals with cardiorenal disease. These statements were expected to serve as useful guidance in the management of hyperkalaemia for health care providers in the region.
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Affiliation(s)
- Desmond Y H Yap
- Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Ronald C W Ma
- Division of Endocrinology and Diabetes, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Emmanuel C K Wong
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Matthew S H Tsui
- Department of Accident and Emergency, Queen Mary Hospital, Hong Kong SAR, China
| | - Esther Y T Yu
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China
| | - Vivien Yu
- Department of Dietetics, Queen Mary Hospital, Hong Kong SAR, China
| | - Cheuk Chun Szeto
- Division of Nephrology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing Fai Pang
- Division of Nephrology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hung Fat Tse
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - David C W Siu
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Kathryn C B Tan
- Endocrinology and Metabolism Division, Department of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Walter W C Chen
- Division of Cardiology, Virtus Medical Group, Hong Kong SAR, China
| | - Chiu Leong Li
- Division of Nephrology, Centro Hospitalar Conde de São Januário, Macau SAR, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tak Mao Chan
- Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong SAR, China
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Esteban-Fernández A, Ortiz Cortés C, López-Fernández S, Recio Mayoral A, Camacho Jurado FJ, Gómez Otero I, Molina M, Almenar Bonet L, López-Vilella R. Experience with the potassium binder patiromer in hyperkalaemia management in heart failure patients in real life. ESC Heart Fail 2022; 9:3071-3078. [PMID: 35748119 DOI: 10.1002/ehf2.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 04/06/2022] [Accepted: 05/08/2022] [Indexed: 11/07/2022] Open
Abstract
AIMS Hyperkalaemia (HK) is common in heart failure (HF) patients, related to renal dysfunction and medical treatment. It limits medical therapy optimization, which impacts prognosis. New potassium (K) binders help control HK, allowing better medical management of HF. METHODS AND RESULTS A retrospective multicentre register included all outpatients with HF and HK (K ≥ 5.1 mEq/L) treated with patiromer according to current recommendations. We evaluated analytic and clinical parameters before starting the treatment and at 7, 30 and 90 days, as well as adverse events related to patiromer and treatment optimization. We included 74 patients (71.6% male) with a mean age of 70.8 years (SD 9.2). Sixty-seven patients (90.5%) presented HK in the previous year. Forty patients (54.1%) underwent down-titration of a renin-angiotensin-aldosterone inhibitor (RAASi) or a mineralocorticoid receptor antagonist (MRA), and 27 (36.5%) stopped any of them due to HK. Initial K was 5.5 mEq/L (SD 0.6), with a significantly reduction at 7 days (4.9 mEq/L (SD 0.8); P < 0.001), maintained at 90 days (4.9 mEq/L (SD 0.8); P < 0.001). There were no other electrolyte disturbances, with a slight improvement in renal function [glomerular filtration rate 39.6 mL/min (SD 20.4) to 42.7 mL/min (SD 23.2); P = 0.005]. Adverse events were reported in 33.9% of patients, the most common being hypomagnesaemia (16.3%), gastrointestinal disturbances (14.9%) and HK (2.8%). Withdrawal of patiromer was uncommon (12.2%) due to gastrointestinal disturbances in 66.7% of cases. Nine patients (12.2%) started on a RAASi, and 15 patients (20.3%) on an MRA during the follow-up. Forty-five patients (60.8%) increased the dose of RAASi or MRA, increasing to target doses in 5.4 and 10.8% of patients, respectively. At 90 days, NTproBNP values were reduced from 2509.5 pg/mL [IQR 1311-4,249] to 1396.0 pg/mL [IQR 804-4263]; P = 0.003, but the reduction was only observed in those who optimized HF medical treatment [NTproBNP from 1950.5 pg/mL (IQR 1208-3403) to 1349.0 pg/mL (IQR 804-2609); P < 0.01]. NYHA functional class only improved in 7.5% of patients, corresponding with those who optimized HF medical treatment. Compared with the previous 3 months before patiromer treatment, the rate of hospitalization was reduced from 28.4 to 10.9% (P < 0.01), and the emergency room visits from 18.9 to 5.4% (P < 0.01). CONCLUSIONS In a real-life cohort of patients with HF, patiromer reduced and maintained K levels during 3 months of follow-up. The most common adverse events were hypomagnesaemia and gastrointestinal disturbances. Patiromer helps optimize medical treatment, increasing the percentage of patients treated with RAASi and MRA at target doses. At the end of follow-up, natriuretic peptides values and hospital visits were reduced, suggesting the benefit of optimizing HF medical treatment.
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Affiliation(s)
- Alberto Esteban-Fernández
- Faculty of Health Sciences, Universidad Alfonso X el Sabio (UAX), Villanueva de la Cañada, Spain
- Cardiology Service, Hospital Universitario Severo Ochoa, Leganés, Spain
| | | | - Silvia López-Fernández
- Heart Failure Unit, Cardiology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
- IDIBELL, Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | | | | | - Inés Gómez Otero
- Cardiology Service, Hospital Universitario de Santiago, A Coruña, Spain
| | - María Molina
- Faculty of Health Sciences, Universidad Alfonso X el Sabio (UAX), Villanueva de la Cañada, Spain
- Cardiology Service, Hospital Universitario Severo Ochoa, Leganés, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplant Unit, Cardiology Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- CIBERCV, Valencia, Spain
| | - Raquel López-Vilella
- Heart Failure and Transplant Unit, Cardiology Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- CIBERCV, Valencia, Spain
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