TY - JOUR
T1 - Frequency and Predictors of Hyperkalemia in Patients >= 60 Years of Age With Heart Failure Undergoing Intense Medical Therapy
AU - Muzzarelli, Stefano
AU - Maeder, Micha Tobias
AU - Toggweiler, Stefan
AU - Rickli, Hans
AU - Nietlispach, Fabian
AU - Julius, Barbara
AU - Burkard, Thilo
AU - Pfisterer, Matthias Emil
AU - Brunner-La Rocca, Hans-Peter
PY - 2012/3/1
Y1 - 2012/3/1
N2 - Hyperkalemia is a concern in heart failure (HF), especially in older patients with comorbidities. Previous studies addressing this issue have focused mainly on younger patients. This study was aimed at determining the frequency and predictors of hyperkalemia in older patients with HF undergoing intense medical therapy. Frequency and predictors of hyperkalemia were defined in patients (n = 566) participating in the Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure, in which patients >= 60 years of age were randomized to a standard versus an intensified N-terminal brain natriuretic peptide-guided HF therapy. During an 18-month follow-up 76 patients (13.4%) had hyperkalemia (>= 5.5 mmol/L) and 28 (4.9%) had severe hyperkalemia (>= 6.0 mmol/L). Higher baseline serum potassium (odds ratio [OR] 2.92 per mmol/L), baseline creatinine (OR 1.11 per 10 mu mol/L), gout (OR 2.56), New York Heart Association (NYHA) class (compared to NYHA class II, IV OR 3.08), higher dosage of spironolactone at baseline (OR 1.20 per 12.5 mg/day), and higher dose changes of spironolactone (compared to no dose change: 12.5 mg, OR 1.45; 25 mg, OR 2.52; >25 mg, OR 3.24) were independent predictors for development of hyperkalemia (p = 60 years of age with HF undergoing intense medical therapy. Risk is increased in patients treated with spironolactone, in addition to patient-specific risk factors such as chronic kidney disease, higher serum potassium, advanced NYHA class, and gout. Careful surveillance of serum potassium and cautious use of spironolactone in patients at risk may help to decrease the incidence of potentially hazardous complications caused by hyperkalemia.
AB - Hyperkalemia is a concern in heart failure (HF), especially in older patients with comorbidities. Previous studies addressing this issue have focused mainly on younger patients. This study was aimed at determining the frequency and predictors of hyperkalemia in older patients with HF undergoing intense medical therapy. Frequency and predictors of hyperkalemia were defined in patients (n = 566) participating in the Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure, in which patients >= 60 years of age were randomized to a standard versus an intensified N-terminal brain natriuretic peptide-guided HF therapy. During an 18-month follow-up 76 patients (13.4%) had hyperkalemia (>= 5.5 mmol/L) and 28 (4.9%) had severe hyperkalemia (>= 6.0 mmol/L). Higher baseline serum potassium (odds ratio [OR] 2.92 per mmol/L), baseline creatinine (OR 1.11 per 10 mu mol/L), gout (OR 2.56), New York Heart Association (NYHA) class (compared to NYHA class II, IV OR 3.08), higher dosage of spironolactone at baseline (OR 1.20 per 12.5 mg/day), and higher dose changes of spironolactone (compared to no dose change: 12.5 mg, OR 1.45; 25 mg, OR 2.52; >25 mg, OR 3.24) were independent predictors for development of hyperkalemia (p = 60 years of age with HF undergoing intense medical therapy. Risk is increased in patients treated with spironolactone, in addition to patient-specific risk factors such as chronic kidney disease, higher serum potassium, advanced NYHA class, and gout. Careful surveillance of serum potassium and cautious use of spironolactone in patients at risk may help to decrease the incidence of potentially hazardous complications caused by hyperkalemia.
U2 - 10.1016/j.amjcard.2011.10.027
DO - 10.1016/j.amjcard.2011.10.027
M3 - Article
C2 - 22152974
SN - 0002-9149
VL - 109
SP - 693
EP - 698
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 5
ER -