Cited by 170Potassium and Related DisordersHeart Failure Treatment and ManagementHormonal Regulation and Hypertension

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Incidence and Predictors of Hyperkalemia in Patients With Heart Failure

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Desai, Akshay S., Swedberg, Karl, McMurray, John J.V., Granger, Christopher B., Yusuf, Salim, Young, James B., Dunlap, Mark E., Solomon, Scott D., Hainer, James W., Olofsson, Bertil, Michelson, Eric L., Pfeffer, Marc A.·2007·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2007.07.067

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Abstract

Objectives We explored the incidence and predictors of hyperkalemia in a broad population of heart failure patients.Background When used in optimal doses to treat patients with heart failure, renin-angiotensin-aldosterone system (RAAS) inhibitors improve clinical outcomes but can cause hyperkalemia.Methods Participants in the CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity) (n = 7,599) Program were randomized to standard heart failure therapy plus candesartan or placebo, titrated as tolerated to a target of 32 mg once daily with recommended monitoring of serum potassium and creatinine. We assessed the incidence and predictors of hyperkalemia associated with dose reduction, study drug discontinuation, hospitalization, or death over the median 3.2 years of follow-up.Results Independent of treatment assignment, the risk of hyperkalemia increased with age > or =75 years, male gender, diabetes, creatinine > or =2.0 mg/dl, K+ > or =5.0 mmol/l, and background use of angiotensin-converting enzyme inhibitors or spironolactone. Candesartan increased the rate of aggregate hyperkalemia from 1.8% to 5.2% (difference 3.4%, p < 0.0001) and serious hyperkalemia (associated with death or hospitalization) from 1.1% to 1.8% (difference 0.7%, p < 0.001), with hyperkalemia associated with death reported in 2 (0.05%) candesartan patients and 1 (0.03%) placebo patient. The benefit of candesartan in reducing cardiovascular death or heart failure hospitalization (relative risk reduction 16%, p < 0.0001) was uniform in these subgroups, as was the incremental risk of hyperkalemia.Conclusions The risk of hyperkalemia is increased in symptomatic heart failure patients with advanced age, male gender, baseline hyperkalemia, renal failure, diabetes, or combined RAAS blockade. Although these groups derive incremental clinical benefit from candesartan, careful surveillance of serum potassium and creatinine is particularly important.

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Authors: Desai, A. S., Swedberg, K., McMurray, J. J. V., Granger, C. B., Yusuf, S., Young, J. B., Dunlap, M. E., Solomon, S. D., Hainer, J. W., Olofsson, B., Michelson, E. L., & Pfeffer, M. A.
Affiliations: Brigham and Women's Hospital (US)
University of Gothenburg (SE)
Western Infirmary (GB)
Duke Medical Center (US)
Cleveland Clinic (US)
Case Western Reserve University (US)
AstraZeneca (United States) (US)
ORCID: Desai, Akshay S.
Swedberg, Karl
McMurray, John J.V.
Granger, Christopher B.
Yusuf, Salim
Young, James B.
Dunlap, Mark E.
Solomon, Scott D.
Pfeffer, Marc A.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2007-11
Volume: 50
Issue: 20
Pages: 1959-1966
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2007.07.067
OpenAlex: W170303893
Cited by: 170
References: 21
Citations by year: 2026: 1 · 2025: 9 · 2024: 9 · 2023: 5 · 2022: 5 · 2021: 11 · 2020: 2 · 2019: 13 · 2018: 14 · 2017: 13 · 2016: 8 · 2015: 4 · 2014: 9 · 2013: 9 · 2012: 15
FWCI: 8.35
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2084 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Nephrology › Potassium and Related Disorders
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords: hyperkalemia, heart failure, candesartan, renin-angiotensin-aldosterone system inhibitors, risk factors, serum potassium monitoring, renal failure, diabetes mellitus, spironolactone, ACE inhibitors, drug safety, cardiovascular mortality
MeSH terms: Aged, Aged, 80 and over, Benzimidazoles, Biphenyl Compounds, Female, Follow-Up Studies, Heart Failure, Humans, Hyperkalemia, Male, Predictive Value of Tests, Retrospective Studies, Risk Factors, Tetrazoles, Incidence, Angiotensin II Type 1 Receptor Blockers

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Incidence and Predictors of Hyperkalemia in Patients With Heart Failure

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