Key result
Hyperkalemia in heart failure requires careful management of RAAS inhibitors, with novel therapies like finerenone and potassium binders offering new strategies to reduce serum potassium levels.
This review highlights the challenges of managing hyperkalemia in heart failure patients on RAAS inhibitors and discusses emerging therapies like finerenone, ARNIs, and novel potassium binders.
In heart failure (HF), hyperkalemia is a frequent problem because of several factors, such as neurohormonal mechanisms involved in the disease, renal failure, comorbidities, and drugs with a prognostic benefit. These drugs can block the renin–angiotensin–aldosterone system, and therefore, serum potassium levels can increase, mostly when combined with other drugs as nonsteroidal anti-inflammatories, digitalis, heparin, etc. Hyperkalemia can have severe consequences if not corrected, mostly at the cardiac level (decrease in speed conduction, QRS enlargement, ventricular arrhythmias, and asystole). Therefore, it is important to adequately prescribe these potentially harmful drugs (starting at low doses with close monitoring of renal function and potassium levels), to carefully manage the factors that can interfere with potassium levels, and to early treat hyperkalemia if it develops. There are several investigation lines for the design of new molecules that show a similar efficacy to that of renin–angiotensin–aldosterone system, with a lower risk of hyperkalemia: nonsteroidal mineralocorticoid receptor antagonists like finerenone, which is a more cardioselective drug than traditional mineralocorticoid receptor antagonists, and angiotensin and neprilysin inhibitors such as LCZ696, which have proven to reduce mortality and heart failure hospitalizations. Besides, new drugs are being studied, which are able to reduce levels of serum potassium in a sustained and faster way, like chelating polymers Patiromer and sodium zirconium cyclosilicate.
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Almenar‐Bonet et al. (2016) conducted a review in Heart failure and hyperkalemia. RAAS inhibitors and novel potassium-lowering therapies was evaluated. Hyperkalemia in heart failure requires careful management of RAAS inhibitors, with novel therapies like finerenone and potassium binders offering new strategies to reduce serum potassium levels.
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