November 16, 2023Open Access

Hypokalemia, Kidney Function, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction

YOYoichiro OtakiYamagata University TWTetsu WatanabeYamagata University RYRyuhei YAMAGUCHIYamagata University

Structured PICO

Does hypokalemia increase the risk of heart failure-related events in patients with HFpEF?

Population

454 patients with heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%), mean age 73.6 years, 54% men, admitted for diagnosis or treatment of acute or chronic HF exacerbation.

Intervention

Hypokalemia (serum potassium <3.5 mmol/L) at admission

Comparator

Control group (serum potassium ≥4.0 mmol/L) and mild hypokalemia (serum potassium 3.5–3.9 mmol/L)

Outcome

Heart failure-related events (composite of hospitalizations due to worsening of HF and HF-related death) at median 1,000 days follow-upcomposite

In patients with HFpEF, hypokalemia at admission is strongly associated with renal tubular damage and independently predicts an increased risk of heart failure-related events.

Abstract

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is an increasing health problem associated with high morbidity and mortality rates. Several reports have shown an association between hypokalemia and clinical outcomes in patients with heart failure (HF). However, the association of hypokalemia with kidney function and clinical outcomes in patients with HFpEF remains unclear. METHODS AND RESULTS: -microglobulin to creatinine ratio ≥300 μg/gCr, preserved estimated glomerular filtration rate (eGFR), and plasma volume expansion. Multivariate logistic analysis demonstrated that RTD, preserved eGFR, and plasma volume expansion were significantly associated with hypokalemia. During the median follow-up period of 1,000 days, 82 HF-related events occurred. Kaplan-Meier analysis showed that patients with hypokalemia had a higher rate of HF-related events than those without hypokalemia. Multivariate Cox proportional hazard regression analysis demonstrated that hypokalemia was significantly associated with HF-related events after adjusting for confounding factors. CONCLUSIONS: Hypokalemia is affected by kidney function, notably RTD, in patients with HFpEF. Hypokalemia is a risk factor for HF-related events in patients with HFpEF.

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