Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye.
Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Eskişehir, Türkiye.
Turk Kardiyol Dern Ars. 2021 Oct;49(Supp1):1-32. doi: 10.5543/tkda.2021.S1.
Hyperkalemia is a common electrolyte abnormality in heart failure (HF) that can cause potentially life-threatening cardiac arrhythmias and sudden cardiac death. HF patients with diabetes, chronic kidney disease and older age are at higher risk of hyperkalemia. Moreover, hyperkalemia is also often associated with the use of renin-angiotensin-aldosterone system inhibitors (RAASi) including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and sacubitril-valsartan. In clinical practice, the occurrence of hyperkalemia is a major concern among the clinicians and often limits RAASi use and/or lead to dose reduction or discontinuation, thereby reducing their potential benefits for HF. Furthermore, recurrent hyperkalemia is frequent in the long-term and is associated with an increase in hyperkalemia-related hospitalizations. Therefore, management of hyperkalemia has a special importance in HF patients. However, treatment options in chronic management are currently limited. Dietary restriction of potassium is usually ineffective with variable adherence. Sodium polystyrene sulfonate is commonly used, but its effectiveness is uncertain and reported to be associated with intestinal toxicity. New therapeutic options such as potassium binders have been suggested as potentially beneficial agents in the management of hyperkalemia. This document discusses prevalence, predictors and management of hyperkalemia in HF, emphasizing the importance of careful patient selection for medical treatment, uptitration of the doses of RAASi, regular surveillance of potassium and treatment options of hyperkalemia.
高钾血症是心力衰竭（HF）中常见的电解质异常，可导致潜在的危及生命的心律失常和心源性猝死。患有糖尿病、慢性肾脏病和年龄较大的 HF 患者发生高钾血症的风险更高。此外，高钾血症也常与肾素-血管紧张素-醛固酮系统抑制剂（RAASi）的使用相关，包括血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、盐皮质激素受体拮抗剂和沙库巴曲缬沙坦。在临床实践中，高钾血症的发生是临床医生关注的主要问题，常限制 RAASi 的使用和/或导致剂量减少或停药，从而降低其对 HF 的潜在益处。此外，高钾血症在长期内经常复发，与高钾血症相关的住院率增加有关。因此，HF 患者的高钾血症管理具有特殊重要性。然而，目前慢性管理的治疗选择有限。钾的饮食限制通常效果不佳，且患者的依从性各不相同。聚苯乙烯磺酸钠通常被使用，但疗效不确定，并被报道与肠道毒性相关。新的治疗选择，如钾结合剂，被认为是高钾血症管理中可能有益的药物。本文讨论了 HF 中高钾血症的流行情况、预测因素和管理，强调了在选择药物治疗时需仔细选择患者、RAASi 剂量递增、定期监测血钾和高钾血症治疗选择的重要性。
