Management of acute hyperkalemia in heart failure – a major challenge

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.