Document Detail


Clinical factors affecting serum potassium concentration in cardio-renal decompensation syndrome.
MedLine Citation:
PMID:  18804879     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Renin-angiotensin-aldosterone system (RAAS) inhibitors are currently indispensable for the treatment of heart failure. It is well known that hyperkalemia is likely to occur in renal failure; however, it has not yet been clarified how the serum potassium concentration changes as heart failure progresses. Currently, the cardio-renal decompensation syndrome holds that the serum potassium concentration is altered similarly by both heart failure and renal failure; however, there are no definitive reports on this. In order to use RAAS inhibitors more safely and effectively in heart failure, it is necessary to understand the factors affecting serum potassium concentration in the clinical setting. METHODS AND RESULTS: We examined the clinical factors affecting serum potassium concentration in 1035 consecutive patients with cardiovascular disease who were hospitalized in our institution. Multiple regression analysis showed that the independent factors associated with an elevated serum potassium concentration were renal insufficiency evaluated by estimated glomerular filtration rate (eGFR) (P<0.0001), diabetes mellitus evaluated by HbA(1c) (P=0.0005) and the use of RAAS inhibitors (P=0.0010). The independent factors associated with a decreased serum potassium concentration were mean blood pressure (P<0.0001), heart failure evaluated by log BNP (P=0.0164) and the use of diuretics (P=0.0232). CONCLUSIONS: The serum potassium concentration decreases with the severity of heart failure if renal function is preserved. From the perspective of potassium homeostasis, we could use the RAAS inhibitors more aggressively in patients with heart failure who do not have renal failure.
Authors:
Hirofumi Ueno; Michihiro Yoshimura; Masafumi Nakayama; Megumi Yamamuro; Tsunenori Nishijima; Kenichi Kusuhara; Yasuhiro Nagayoshi; Sunao Kojima; Koichi Kaikita; Hitoshi Sumida; Seigo Sugiyama; Hisao Ogawa
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-09-19
Journal Detail:
Title:  International journal of cardiology     Volume:  138     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-04-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  174-81     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Child
Disease Progression
Diuretics / therapeutic use*
Female
Glomerular Filtration Rate / physiology
Heart Failure* / blood,  complications,  drug therapy
Humans
Hyperkalemia* / blood,  complications,  drug therapy
Kidney Failure* / blood,  complications,  drug therapy
Male
Middle Aged
Natriuretic Peptide, Brain / blood
Potassium / blood*
Regression Analysis
Renin-Angiotensin System / drug effects,  physiology
Severity of Illness Index
Spironolactone / therapeutic use*
Young Adult
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 114471-18-0/Natriuretic Peptide, Brain; 52-01-7/Spironolactone; 7440-09-7/Potassium

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