射血分数降低的心力衰竭（HFrEF）门诊患者在优化指南指导的药物治疗过程中高钾血症的发生率。
Frequency of hyperkalemia during optimization of guideline-directed medical therapy in ambulatory patients with HFrEF.
作者信息
Mendoza-Zavala Genaro H, Reynoso-Hernandez Gibran, Posada-Martinez Edith L, Sandoval-Jimenez Miguel, Alejo-Arcos Jairo I A, Rios-Felix Kassandra, Amaro-Balderas Eileen, Gomez-Lopez Marisol, Juarez-Comboni Sonia C, Tejado-Gallegos Luis F, Joachin-Sanchez Emerson, Olmos-Dominguez Luis, Aceves-Garcia Moises, Olalde-Roman Marco J, Silva-Garcia Marissa A, Almeida-Gutierrez Eduardo, Revilla-Monsalve Cristina, Chavez-Mendoza Adolfo, Cigarroa-Lopez Jose A, Chávez-Iñiguez Jonathan S, Magaña-Serrano Jose A, Ivey-Miranda Juan B
机构信息
Department of Heart Failure, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Department of Echocardiography, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico.
出版信息
Front Cardiovasc Med. 2025 May 9;12:1562647. doi: 10.3389/fcvm.2025.1562647. eCollection 2025.
BACKGROUND
The frequency of hyperkalemia in patients with heart failure with reduced ejection fraction (HFrEF) receiving a high percentage of quadruple guideline-directed medical therapy (GDMT) has not been described extensively. The consequences of hyperkalemia on modifications in GDMT have not been fully addressed in patients receiving quadruple therapy.
METHODS
This was a retrospective cohort study of outpatients with HFrEF treated at a specialized heart failure clinic. A case-by-case retrospective review of patients fulfilling the selection criteria was conducted by dedicated personnel. The main exposure was the occurrence of hyperkalemia at any visit, and the primary outcome was the modification in GDMT following hyperkalemia.
RESULTS
We included 1,279 medical encounters from 500 unique patients. Over a mean follow-up of 11 ± 7 months (2.6 ± 0.9 visits), the proportion of patients receiving angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, beta-blockers, spironolactone, sodium-glucose co-transporter 2 inhibitors (SGLT2is), and quadruple therapy increased to 98.6%, 99.0%, 97.4%, 93%, and 89.6%, respectively ( < 0.001 compared to baseline). The proportion of hyperkalemia during follow-up, defined as serum potassium >5.0,>5.5, and >6.0 mmol/L at any visit, was 44.4%, 13.0%, and 4.0%, respectively. In multivariable analysis, estimated glomerular filtration rate was the only independent predictor of hyperkalemia across all cutoff values ( < 0.001 for all). Serum potassium was associated with greater odds of mineralocorticoid receptor antagonist (MRA) discontinuation in a non-linear fashion, with an increased risk starting at >5.0 mmol/L ( < 0.001). Initiation of SGLT2is was not associated with lower odds of developing hyperkalemia at subsequent visits ( > 0.20 for all cutoff values).
CONCLUSIONS
Hyperkalemia >5.0 mmol/L is highly prevalent in patients with HFrEF receiving quadruple GDMT. Even with mild hyperkalemia, discontinuation of MRAs remains the primary strategy for managing this complication.
背景
射血分数降低的心力衰竭（HFrEF）患者中，接受高比例四重指南指导药物治疗（GDMT）时高钾血症的发生率尚未得到广泛描述。在接受四重治疗的患者中，高钾血症对GDMT调整的影响尚未得到充分探讨。
方法
这是一项在专门的心力衰竭诊所对HFrEF门诊患者进行的回顾性队列研究。由专人对符合入选标准的患者进行逐例回顾性分析。主要暴露因素是在任何一次就诊时发生高钾血症，主要结局是高钾血症后GDMT的调整。
结果
我们纳入了500例独特患者的1279次就诊记录。在平均11±7个月（2.6±0.9次就诊）的随访期间，接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂、β受体阻滞剂、螺内酯、钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）和四重治疗的患者比例分别增至98.6%、99.0%、97.4%、93%和89.6%（与基线相比，<0.001）。随访期间，定义为任何一次就诊时血清钾>5.0、>5.5和>6.0 mmol/L的高钾血症比例分别为44.4%、13.0%和4.0%。在多变量分析中，估计肾小球滤过率是所有临界值下高钾血症的唯一独立预测因素（所有P<0.001）。血清钾与盐皮质激素受体拮抗剂（MRA）停药几率呈非线性相关，血清钾>5.0 mmol/L时风险增加（P<0.001）。开始使用SGLT2i与后续就诊时发生高钾血症的几率较低无关（所有临界值下P>0.20）。
结论
接受四重GDMT的HFrEF患者中，血钾>5.0 mmol/L的高钾血症非常普遍。即使是轻度高钾血症，停用MRA仍然是处理这一并发症的主要策略。
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