Ali Ibrahim, Green Darren, Kalra Paul, Kalra Philip A
Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, UK.
Department of Cardiology, Portsmouth Hospital NHS Trust, Portsmouth, UK.
Cardiorenal Med. 2022;12(5-6):196-204. doi: 10.1159/000526106. Epub 2022 Aug 31.
Renin-angiotensin-aldosterone system inhibitors (RAASi) improve prognosis in patients with heart failure with reduced ejection fraction (HFrEF), but suboptimal dosing or discontinuation of these medications often occurs due to RAASi-associated hyperkalaemia. We established a nephrology-led hyperkalaemia clinic to oversee prescribing of patiromer, an oral potassium binder, to facilitate RAASi optimization.
The clinic was established in July 2019 at a nephrology tertiary centre in the UK. Patients with HFrEF who were unable to increase RAASi dosage due to hyperkalaemia were referred to the clinic, where all patients commenced patiromer 8.4 g daily. RAASi adjustments were deferred to the referring teams. Study outcomes included the percentage of patients who achieved a RAASi dose increase and the proportion of patients with normokalaemia at follow-up. Outcomes were evaluated until 1 May 2021.
A total of 34 patients were reviewed in the clinic between July 2019 and December 2020. Mean age was 71.6 years (±10.6 years), 56% had diabetes, and 71% had chronic kidney disease stages 3a-5; mean estimated glomerular filtration rate was 56 mL/min/1.73 m2 (±21 mL/min/1.73 m2). During follow-up, 13 patients discontinued patiromer (6 of whom did so due to gastrointestinal side effects) and were discharged; 2 patients died from non-hyperkalaemia-related illness; one switched to an alternative potassium binder. Over a mean follow-up of 13.4 months (±5.8 months), 17 of the 20 patients (85%) who continued with a potassium binder achieved a RAASi dose increase, with 4 patients (20%) receiving maximal dosages. This was attained by achieving normokalaemia during follow-up. No patients required magnesium supplementation. Of the 19 patients on patiromer, 12 continued this therapy for more than 12 months and 4 received it safely for 20 months.
DISCUSSION/CONCLUSION: Patiromer prescribing in a nephrology-led hyperkalaemia clinic facilitated RAASi up-titration in patients with HFrEF by controlling potassium levels.
肾素-血管紧张素-醛固酮系统抑制剂（RAASi）可改善射血分数降低的心力衰竭（HFrEF）患者的预后，但由于RAASi相关的高钾血症，这些药物的剂量往往未达最佳或被停用。我们设立了一个由肾脏病科主导的高钾血症诊所，以监督口服钾结合剂帕替罗姆的处方开具情况，以促进RAASi的优化使用。
该诊所在2019年7月于英国一家肾脏病三级中心设立。因高钾血症而无法增加RAASi剂量的HFrEF患者被转诊至该诊所，所有患者均开始每日服用8.4 g帕替罗姆。RAASi的调整由转诊团队负责。研究结果包括实现RAASi剂量增加的患者百分比以及随访时血钾正常的患者比例。研究结果评估至2021年5月1日。
2019年7月至2020年12月期间，该诊所共对34例患者进行了评估。平均年龄为71.6岁（±10.6岁），56%的患者患有糖尿病，71%的患者患有3a-5期慢性肾脏病；平均估算肾小球滤过率为56 mL/min/1.73 m²（±21 mL/min/1.73 m²）。在随访期间，13例患者停用了帕替罗姆（其中6例因胃肠道副作用停药）并出院；2例患者死于非高钾血症相关疾病；1例患者改用了另一种钾结合剂。在平均13.4个月（±5.8个月）的随访中，继续使用钾结合剂的20例患者中有17例（85%）实现了RAASi剂量增加，4例患者（20%）达到了最大剂量。这是通过在随访期间实现血钾正常来实现的。没有患者需要补充镁。在服用帕替罗姆的19例患者中，12例继续接受该治疗超过12个月，4例安全服用了20个月。
讨论/结论：在由肾脏病科主导的高钾血症诊所开具帕替罗姆处方，通过控制血钾水平促进了HFrEF患者RAASi剂量的上调。
