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Cardiologia Croatica, Vol. 19 No. 11-12, 2024.

Meeting abstract

https://doi.org/10.15836/ccar2024.423

Hyperkalemia and angiotensin-converting enzyme inhibitor/angiotensin receptor neprilysin inhibitor titration in the era of sodium-glucose cotransporter 2 inhibitors

Domagoj Kobetić orcid id orcid.org/0009-0000-2106-4933 ; Pakrac General Hospital and the Croatian Veterans Hospital, Pakrac, Croatia
Ante Lisičić orcid id orcid.org/0000-0002-4365-9652 ; Dubrava University Hospital, Zagreb, Croatia
Aleksandar Blivajs orcid id orcid.org/0000-0003-3404-3837 ; Dubrava University Hospital, Zagreb, Croatia
Nikola Pavlović orcid id orcid.org/0000-0001-9187-7681 ; Dubrava University Hospital, Zagreb, Croatia
Tomo Svaguša orcid id orcid.org/0000-0002-2036-1239 ; Dubrava University Hospital, Zagreb, Croatia
Petra Vitlov orcid id orcid.org/0000-0001-6983-1409 ; Dubrava University Hospital, Zagreb, Croatia
Irzal Hadžibegović orcid id orcid.org/0000-0002-3768-9134 ; Dubrava University Hospital, Zagreb, Croatia
Ana Jordan orcid id orcid.org/0000-0001-5610-6259 ; Dubrava University Hospital, Zagreb, Croatia
Danijela Grizelj orcid id orcid.org/0000-0002-8298-7974 ; Dubrava University Hospital, Zagreb, Croatia
Mario Udovičić orcid id orcid.org/0000-0001-9912-2179 ; Dubrava University Hospital, Zagreb, Croatia
Ivan Zeljković orcid id orcid.org/0000-0002-4550-4056 ; Dubrava University Hospital, Zagreb, Croatia
Petar Lišnjić orcid id orcid.org/0009-0003-7890-6531 ; University of Zagreb School of Medicine, Zagreb, Croatia
Tomislav Šipić orcid id orcid.org/0000-0001-8652-4523 ; Dubrava University Hospital, Zagreb, Croatia
Luka Antolković orcid id orcid.org/0000-0002-5313-2213 ; Dubrava University Hospital, Zagreb, Croatia
Fran Rode orcid id orcid.org/0000-0002-8787-2455 ; Dubrava University Hospital, Zagreb, Croatia
Jasmina Ćatić orcid id orcid.org/0000-0001-6582-4201 ; Dubrava University Hospital, Zagreb, Croatia
Marin Pavlov orcid id orcid.org/0000-0003-3962-2774 ; Dubrava University Hospital, Zagreb, Croatia
Šime Manola orcid id orcid.org/0000-0001-6444-2674 ; Dubrava University Hospital, Zagreb, Croatia
Ivana Jurin orcid id orcid.org/0000-0002-2637-9691 ; Dubrava University Hospital, Zagreb, Croatia

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Abstract

Keywords

hyperkalemia; angiotensin-converting enzyme inhibitors; angiotensin receptor neprilysin inhibitors

Hrčak ID:

327913

URI

https://hrcak.srce.hr/327913

Publication date:

13.12.2024.

Visits: 350 *

Copyright statement: Croatian Cardiac Society

Copyright: 2024, Croatian Cardiac Society

Date received: 13 October 2024

Date: 31 October 2024

Publication date: November 2024

Publication date: November 2024

Volume: 19

Issue: 11-12

Page: 423

Publisher ID: CC 2024 19_11-12_423

DOI: 10.15836/ccar2024.423

Article Information (continued)

Categories:

Subject: Extended Abstract

Categories:

Subject: Heart failure

KEYWORDS: :

KEYWORDS:

Keyword: hyperkalemia

Keyword: angiotensin-converting enzyme inhibitors

Keyword: angiotensin receptor neprilysin inhibitors

Hyperkalemia and angiotensin-converting enzyme inhibitor/angiotensin receptor neprilysin inhibitor titration in the era of sodium-glucose cotransporter 2 inhibitors

[https://orcid.org/0009-0000-2106-4933] Domagoj Kobetić[1][*]

[https://orcid.org/0000-0002-4365-9652] Ante Lisičić[2]

[https://orcid.org/0000-0003-3404-3837] Aleksandar Blivajs[2]

[https://orcid.org/0000-0001-9187-7681] Nikola Pavlović[2]

[https://orcid.org/0000-0002-2036-1239] Tomo Svaguša[2]

[https://orcid.org/0000-0001-6983-1409] Petra Vitlov[2]

[https://orcid.org/0000-0002-3768-9134] Irzal Hadžibegović[2]

[https://orcid.org/0000-0001-5610-6259] Ana Jordan[2]

[https://orcid.org/0000-0002-8298-7974] Danijela Grizelj[2]

[https://orcid.org/0000-0001-9912-2179] Mario Udovičić[2]

[https://orcid.org/0000-0002-4550-4056] Ivan Zeljković[2]

[https://orcid.org/0009-0003-7890-6531] Petar Lišnjić[3]

[https://orcid.org/0000-0001-8652-4523] Tomislav Šipić[2]

[https://orcid.org/0000-0002-5313-2213] Luka Antolković[2]

[https://orcid.org/0000-0002-8787-2455] Fran Rode[2]

[https://orcid.org/0000-0001-6582-4201] Jasmina Ćatić[2]

[https://orcid.org/0000-0003-3962-2774] Marin Pavlov[2]

[https://orcid.org/0000-0001-6444-2674] Šime Manola[2]

[https://orcid.org/0000-0002-2637-9691] Ivana Jurin[2]

 

[1] Pakrac General Hospital and the Croatian Veterans Hospital, Pakrac, Croatia

[2] Dubrava University Hospital, Zagreb, Croatia

[3] University of Zagreb School of Medicine, Zagreb, Croatia

Author notes:

Correspondence to: [*] ADDRESS FOR CORRESPONDENCE: Domagoj Kobetić, Opća bolnica Pakrac, Bolnička ulica 74, HR-34550 Pakrac, Croatia. / Phone: +385-99-731-6602 / E-mail: domagoj5945@gmail.com

Introduction: Angiotensin-converting enzyme inhibitors (ACEi) have been a key drug in treating heart failure with reduced (HFrEF) and mildly reduced ejection fraction (HFmrEF), with angiotensin receptor neprilysin inhibitors (ARNI) now proposed as a replacement. Guidelines recommend up-titrating these agents to the maximum tolerable dose for optimal benefit. (1) However, both ACEi and ARNI can increase potassium levels, leading to suboptimal dosing due to hyperkalemia concerns. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to reduce hyperkalemia risk in some patients. This study aimed to assess the prevalence of hyperkalemia in HFrEF and HFmrEF patients and its’ effect on achieving optimal medical treatment.

Patients and Methods: This registry-based study included HFrEF and HFmrEF patients hospitalized at our center between September 2021 and December 2023. Levels above 4.7 mmol/L were considered as a cut-off for high potassium.

Results: A total of 764 HFrEF and HFmrEF patients were included, with 19.4% having HFmrEF and 80.6% HFrEF. The mean age was 68 years (range 27-90), and 73.3% were male. Potassium levels increased in 38.9% of patients after therapy implementation. 11.5% received the target doses of ACEi or ARNI. At therapy initiation, 22.8% had potassium levels ≥4.7 mmol/L. No significant association was found between potassium levels and the maximum ACEi/ARNI dose before SGLT2i use. Hyperkalemia prevented 2.4% of patients from receiving the maximum ACEi/ARNI dose. In HFmrEF, more patients were on medium to high ACEi doses at discharge compared to dose at admission. The most common reason for not achieving the maximum dose was low blood pressure or lack of regimen adherence.

Conclusion: In summary, while hyperkalemia impacted ACEi and ARNI dosing in a small portion of patients, it was not a major factor at inadequate therapy titration. Despite ACEi and ARNI raising potassium levels, factors like diuretic use and SGLT2i contributed to decrease in potassium levels in more patients.

LITERATURE

1 

Delgado-Jiménez JF, Segovia-Cubero J, Almenar-Bonet L, de Juan-Bagudá J, Lara-Padrón A, García-Pinilla JM, et al. Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics. J Clin Med. 2022 February 22;11(5):1170. https://doi.org/10.3390/jcm11051170 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/35268260

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