Abstract:
Background. Hyperkalemia is an entity with high prevalence in patients with heart failure
(HF). Elevated potassium levels in HF represent both a direct risk of cardiovascular
complications and an indirect biomarker of the severity of the underlying pathology,
reflecting neurohormonal activation and renal dysfunction.
Objective(s). The literature review aims to present an effective and staged treatment
regimen for the treatment of acute hyperkalemia in patients with HF and comorbidities,
according to the latest recommendations.
Materials and methods. Specialized articles were selected and analyzed from the scientific
library PubMed and the official pages of the European societies of cardiology, intensive care
with an emphasis on treatment and correction methods depending on the degree of
hyperkalemia: mild (5.5-5.9 mmol/l), moderate (6.0-6.4 mmol/l), severe (≥6.5 mmol/l).
Results. According to the European Resuscitation Council Guidelines, in case of mild
hyperkalemia, serum K+ and blood glucose levels are monitored. In case of moderate and
severe hyperkalemia, ECG is examined. In case of changes, Calcium i/v is administered, if not
– i/v infusion of Insulin-Glucose to prevent hypoglycemia. Salbutamol is then administered
via nebulizer to complete the process of K+ transfer into the cells. To eliminate the surplus
of K+ from the body, potassium chelators are administered – Sodium zirconium cyclosilicate
(SZC) or Patiromer, with dynamic monitoring of serum K+ and blood glucose. In case of BCR,
dialysis is recommended.
Conclusion(s). New potassium-sparing drugs, such as patiromer and sodium zirconium
cyclosilicate, can optimize the therapy of hyperkalemia in chronic heart failure, administer
target doses of RAAS inhibitors, improve prognosis, and reduce the risk of cardiovascular
complications, and major cardiac events.
