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Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (2): 241-252     DOI: 10.31083/j.rcm.2020.02.8
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Hyperkalemia in heart failure: current treatment and new therapeutic perspectives
Chiara Minà1, *(), Laura Ajello1, Gabriele Di Gesaro1, Calogero Falletta1, Francesco Clemenza1
1Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo. Via Tricomi 5, 90127 Palermo, Italy
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Abstract:
Hyperkalemia in heart failure is a condition that can occur with relative frequency because it is related to pathophysiological aspects of the disease, and favored by drugs that form the basis of chronic cardiac failure therapy. Often, associated comorbidities, such as kidney failure or diabetes mellitus can further adversely affect potassium levels. Hyperkalemia can result in acute and even severe clinical manifestations that put patients at risk. On the other hand, the finding of hyperkalemia in a chronic context can lead to a reduction in dosages or to suspension of drugs such as angiotensin-converting enzymes inhibitor, angiotensin receptor blocker, angiotensin receptor neprilysin inhibitor, and mineralcorticoid receptor antagonist, first line in the treatment of the disease, with negative effects in prognostic terms. Therapies for the correction of hyperkalemia have so far mainly concerned the treatment of acute clinical pictures. Newly developed molecules, such as patiromer or sodium zirconium cyclosilicate, now open new prospectives in the long-term management of hyperkalemia, and allow us to glimpse the possibility of a better titration of the cardinal drugs for heart failure, with consequent positive effects on patient prognosis. The aim of this review is to focus on the problem of hyperkalemia in the setting of heart failure, with particular regard to its incidence, its prognostic role, and the underlining pathophysiological mechanisms. The review also provides an overview of therapeutic strategies for correcting hyperkalemia in acute and chronic conditions, with a focus on the new potassium binders that promise to improve management of heart failure.
Key words:  Potassium      heart failure      hyperkalemia      renin-angiotensin-aldosterone system inhibitors      patiromer      sodium zirconium cyclosilicate     
Submitted:  31 January 2020      Revised:  12 April 2020      Accepted:  20 April 2020      Published:  30 June 2020     
*Corresponding Author(s):  Chiara Minà     E-mail:  cmina@ismett.edu

Cite this article: 

Chiara Minà, Laura Ajello, Gabriele Di Gesaro, Calogero Falletta, Francesco Clemenza. Hyperkalemia in heart failure: current treatment and new therapeutic perspectives. Reviews in Cardiovascular Medicine, 2020, 21(2): 241-252.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.02.8     OR     https://rcm.imrpress.com/EN/Y2020/V21/I2/241

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