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Management of RAASi-associated hyperkalemia in patients with cardiovascular disease

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dc.contributor.authorSilva-Cardoso, José
dc.contributor.authorBrito, Dulce
dc.contributor.authorFrazão, João Miguel
dc.contributor.authorFerreira, Aníbal
dc.contributor.authorBettencourt, Paulo
dc.contributor.authorBranco, Patrícia
dc.contributor.authorFonseca, Cândida
dc.date.accessioned2021-02-22T16:52:52Z
dc.date.available2021-02-22T16:52:52Z
dc.date.issued2021
dc.description© The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/pt_PT
dc.description.abstractRenin-angiotensin-aldosterone system inhibitors (RAASi) reduce morbidity and mortality in heart failure (HF) with reduced ejection fraction in a dose-dependent manner. They also have a positive impact in other cardiovascular diseases (CVDs). However, RAASi may induce hyperkalemia, a potentially life-threatening disorder. This risk is further increased in those with concomitant chronic kidney disease, diabetes mellitus, and/or in patients with hypertension. Current treatment guidelines recommend maximal RAASi dosing to improve clinical outcomes; however, this is often limited by the development of hyperkalemia. When this occurs, current guidelines recommend RAASi down-titration/interruption, which, while improving short-term prognosis, is associated with a negative long-term prognostic impact. At present, the European Society of Cardiology suggests the consideration of novel potassium binders (patiromer and sodium zirconium cyclosilicate) for the management of RAASi-associated hyperkalemia. Both drugs can reduce serum potassium levels and prevent recurrent hyperkalemia. Additionally, patiromer showed enabling of RAASi optimization in high-risk patients. Nevertheless, precise recommendations on the use of these drugs are lacking. Building upon current HF guideline recommendations, a multidisciplinary expert panel convened to design an algorithm providing practical guidance on the use of novel potassium binders/patiromer in patients with HF and/or other CVD. As a result of that effort, we present an evidence-based treatment algorithm for the management of hyperkalemia with novel potassium binders/patiromer in patients with HF and/or other CVD receiving RAASi, including the necessary monitoring to avoid induction of hypokalemia. This algorithm aims to maintain or up-titrate RAASi to optimized doses, while maintaining normokalemia, improved clinical outcomes, and long-term prognosis.pt_PT
dc.description.sponsorshipThis work was supported by Vifor Pharma, Portugal, via an educational grant.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationHeart Fail Rev. 2021 Feb 18pt_PT
dc.identifier.doi10.1007/s10741-020-10069-3pt_PT
dc.identifier.eissn1573-7322
dc.identifier.issn1382-4147
dc.identifier.urihttp://hdl.handle.net/10451/46459
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringer Naturept_PT
dc.relation.publisherversionhttps://www.springer.com/journal/10741pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectNovel potassium binderspt_PT
dc.subjectHeart failure with reduced ejection fractionpt_PT
dc.subjectRenin–angiotensin–aldosterone system inhibitorspt_PT
dc.subjectHyperkalemiapt_PT
dc.subjectRAASi optimizationpt_PT
dc.titleManagement of RAASi-associated hyperkalemia in patients with cardiovascular diseasept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titleHeart Failure Reviewspt_PT
person.familyNameBrito
person.givenNameDulce
person.identifier.ciencia-idF216-586F-1762
person.identifier.orcid0000-0003-1278-1847
person.identifier.ridG-9650-2016
person.identifier.scopus-author-id7004510538
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication196a2934-1434-433c-9735-81acb6fbe587
relation.isAuthorOfPublication.latestForDiscovery196a2934-1434-433c-9735-81acb6fbe587

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