Masi Stefano, Dalpiaz Herman, Piludu Sara, Piani Federica, Fiorini Giulia, Borghi Claudio
Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Italy.
Eur J Intern Med. 2025 Feb;132:18-26. doi: 10.1016/j.ejim.2024.10.016. Epub 2024 Nov 2.
Renin-angiotensin-aldosterone system inhibitors (RAASi) and mineralocorticoid receptor antagonists (MRAs) are key drugs in the management of patients with cardiovascular diseases (CVD), particularly those with hypertension, diabetes, chronic kidney disease and heart failure (HF), given their demonstrated effectiveness in reducing the risk of both surrogate and hard endpoints. Despite their positive impact on the outcome, patients with RAASi and MRAs are particularly vulnerable to hyperkalaemia, with approximately 50 % of these individuals experiencing two or more recurrences annually. The common practice of reducing the dose or discontinuing the treatment with RAASi and MRAs in conditions of hyperkalaemia results in suboptimal management of these patients, with a potential impact on their mortality and morbidity risk. Recent guidelines from cardiovascular and renal international societies increasingly recognize the need for alternative strategies to manage the risk of hyperkalaemia, allowing the continuation of RAASi and MRA therapies. In this review, we summarise the new potential options available to manage hyperkalaemia in patients with CVD and the recommendations of the most recent guidelines on the topic.
肾素-血管紧张素-醛固酮系统抑制剂（RAASi）和盐皮质激素受体拮抗剂（MRA）是心血管疾病（CVD）患者管理中的关键药物，尤其是对于高血压、糖尿病、慢性肾病和心力衰竭（HF）患者，因为它们在降低替代终点和硬性终点风险方面已被证明有效。尽管它们对结局有积极影响，但使用RAASi和MRA的患者特别容易发生高钾血症，每年约有50%的此类患者会出现两次或更多次复发。在高钾血症情况下减少RAASi和MRA剂量或停止治疗的常见做法导致这些患者的管理不理想，对其死亡和发病风险有潜在影响。心血管和肾脏国际学会的最新指南越来越认识到需要采用替代策略来管理高钾血症风险，以便继续使用RAASi和MRA疗法。在本综述中，我们总结了用于管理CVD患者高钾血症的新潜在选择以及该主题最新指南的建议。
