心力衰竭(HF)患者,特别是那些肾功能受损接受肾素-血管紧张素-醛固酮系统抑制剂(RAASis),有高钾血症的风险;当高钾血症严重时,这可能会产生严重的临床后果。发病率,患病率,由于排除了血清钾升高(sK+)或严重肾功能损害的患者,RAASis随机试验中报道的高钾血症危险因素可能无法反映临床实践:常规临床治疗患者的信息对于了解高钾血症的实际负担很重要.本文回顾了有关HF高钾血症的可用临床流行病学数据,并考虑了需要进一步研究的领域。自2017年以来发表的针对高钾血症的观察性研究,包括HF患者,并考虑≥1000名参与者.HF的高钾血症发生率差异很大,从7%到39%,取决于环境。HF严重程度,随访长度,和伴随的药物。新诊断的心力衰竭患者的发病率最低,疾病严重程度较高的患者的发病率最高;合并症,比如慢性肾病和糖尿病,和RAASI使用,反映了HF患者高钾血症的常见危险因素。高钾血症通常是轻度的;然而,从可用的有限数据中,轻度高钾血症的持续存在与死亡率和主要不良心血管事件的风险增加相关.关于高钾血症进展的可用数据也有限。复发很常见,发生在四分之一到五分之二的高钾血症病例中。尽管HF指南建议密切监测sK+,55-93%的患者在开始RAASi之前或之后或在中/重度高钾血症检测的随访中未接受适当的检测。许多观察性研究是回顾性的,来自一个国家。国际需要,prospective,纵向,观察性研究,例如CARE-HK在HF研究(NCT04864795),了解高钾血症的患病率,发病率,和严重性;识别和表征持续存在的病例,进展,强调使用RAASi时sK+监测的重要性;并评估新的HF疗法和钾结合剂在临床实践中的影响。需要来自临床试验和观察性研究的数据,并对混杂变量进行调整,以评估高钾血症对临床结果的贡献。
Patients with heart failure (HF), particularly those with impaired renal function receiving renin-angiotensin-aldosterone system inhibitors (RAASis), are at risk of hyperkalaemia; when
hyperkalaemia is severe, this can have serious clinical consequences. The incidence, prevalence, and risk factors for
hyperkalaemia reported in randomized trials of RAASis may not reflect clinical practice due to exclusion of patients with elevated serum potassium (sK+) or severe renal impairment: information on patients managed in routine clinical care is important to understanding the actual burden of hyperkalaemia. This paper reviews the available clinical epidemiology data on hyperkalaemia in HF and considers areas requiring further research. Observational studies published since 2017 that focused on hyperkalaemia, included patients with HF, and had ≥1000 participants were considered. Hyperkalaemia occurrence in HF varied widely from 7% to 39% depending on the setting, HF severity, follow-up length, and concomitant medications. Rates were lowest in patients with newly diagnosed HF and highest in patients with greater disease severity; comorbidities, such as chronic kidney disease and diabetes, and RAASi use, reflected commonly identified risk factors for hyperkalaemia in patients with HF.
Hyperkalaemia was most often mild; however, from the limited data available, persistence of mild
hyperkalaemia was associated with an increased risk of mortality and major adverse cardiovascular events. There were also limited data available on the progression of
hyperkalaemia. Recurrence was common, occurring in one-quarter to two-fifths of
hyperkalaemia cases. Despite HF guidelines recommending close monitoring of sK+, 55-93% of patients did not receive appropriate testing before or after initiation of RAASi or in follow-up to moderate/severe hyperkalaemia detection. Many of the observational studies were retrospective and from a single country. There is a need for international, prospective, longitudinal, observational studies, such as the CARE-HK in HF study (NCT04864795), to understand hyperkalaemia\'s prevalence, incidence, and severity; to identify and characterize cases that persist, progress, and recur; to highlight the importance of sK+ monitoring when using RAASi; and to assess the impact of newer HF therapies and potassium binders in clinical practice. Data from both clinical trials and observational studies with adjustments for confounding variables will be needed to assess the contribution of hyperkalaemia to clinical outcomes.