Paolillo Stefania, Basile Christian, Dell'Aversana Simona, Esposito Immacolata, Chirico Alfonsina, Colella Angela, Esposito Gennaro, Santo Mariafrancesca Di, Fierro Maria Francesca, Carbone Francesca, Marzano Federica, Amato Chiara, Gargiulo Paola, Perrone Filardi Pasquale
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Eur J Intern Med. 2024 Jan;119:109-117. doi: 10.1016/j.ejim.2023.08.022. Epub 2023 Aug 28.
Hyperkalemia often occurs among heart failure (HF) patients, particularly when treated with renin-angiotensin-aldosterone system inhibitors (RAASi). Even modest potassium levels variations raise the risk of mortality and prompt patients to discontinue disease-modifying treatment, as RAASi. Novel potassium binders (NPB), patiromer and sodium zirconium cyclosilicate, are effective in reducing potassium levels and are approved for the treatment of hyperkalemia in HF, but whether their use results in a real optimization of HF treatment remains to be seen. The aim of the present meta-analysis was to assess the efficacy of NPB on the optimization of RAASi therapy in HF patients.
PubMed, Web of Science and Clinicaltrial.gov were searched without restrictions from inception to 06 August 2022 to identify valuable articles. The studies that met the inclusion criteria were analyzed. The prespecified primary outcome was the optimization of RAASi therapy in HF patients, defined as the proportion of patients on RAASi at the end of follow-up. Secondary outcomes were hyperkalemia events, reduction in potassium levels, and adverse drugs reactions. Six studies with a total of 1390 patients were included. NPB improved RAASi therapy optimization in HF by 14% (95% CI: 4-26%), decreased hyperkalemia events by 29% (95% CI: 55-92%), and reduced potassium levels by 0.31 mEq/L (95% CI: 0.18-0.44) compared to placebo, maintaining a good safety profile.
NPB are effective in allowing RAASi therapy optimization in patients affected by HF, in reducing hyperkalemia events and potassium levels.
CRD42022351811 URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351811.
高钾血症常发生于心衰（HF）患者中，尤其是在接受肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗时。即使是适度的血钾水平变化也会增加死亡风险，并促使患者停用如RAASi等改善病情的治疗药物。新型钾结合剂（NPB），如帕替罗姆和环硅酸锆钠，可有效降低血钾水平，并已获批用于治疗HF患者的高钾血症，但它们的使用是否能真正优化HF治疗仍有待观察。本荟萃分析的目的是评估NPB对优化HF患者RAASi治疗的疗效。
检索了PubMed、科学网和Clinicaltrial.gov，检索时间从建库至2022年8月6日，无任何限制，以识别有价值的文章。对符合纳入标准的研究进行分析。预先设定的主要结局是HF患者RAASi治疗的优化，定义为随访结束时接受RAASi治疗的患者比例。次要结局包括高钾血症事件、血钾水平降低和药物不良反应。纳入了6项研究，共1390例患者。与安慰剂相比，NPB使HF患者的RAASi治疗优化率提高了14%（95%CI：4%-26%），高钾血症事件减少了29%（95%CI：55%-92%），血钾水平降低了0.31 mEq/L（95%CI：0.18-0.44），且安全性良好。
NPB可有效优化HF患者的RAASi治疗，减少高钾血症事件和降低血钾水平。
CRD42022351811 网址：https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351811
