Incidence and Predictors of Hyperkalemia in Patients With Heart Failure: An Analysis of the CHARM Program Export

@article{citeulike:5418012, abstract = {ObjectivesWe explored the incidence and predictors of hyperkalemia in a broad population of heart failure patients. BackgroundWhen used in optimal doses to treat patients with heart failure, renin-angiotensin-aldosterone system (RAAS) inhibitors improve clinical outcomes but can cause hyperkalemia. MethodsParticipants in the CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity) (n = 7,599) Program were randomized to standard heart failure therapy plus candesartan or placebo, titrated as tolerated to a target of 32 mg once daily with recommended monitoring of serum potassium and creatinine. We assessed the incidence and predictors of hyperkalemia associated with dose reduction, study drug discontinuation, hospitalization, or death over the median 3.2 years of follow-up. ResultsIndependent of treatment assignment, the risk of hyperkalemia increased with age [≥]75 years, male gender, diabetes, creatinine [≥]2.0 mg/dl, K+ [≥]5.0 mmol/l, and background use of angiotensin-converting enzyme inhibitors or spironolactone. Candesartan increased the rate of aggregate hyperkalemia from 1.8\% to 5.2\% (difference 3.4\%, p < 0.0001) and serious hyperkalemia (associated with death or hospitalization) from 1.1\% to 1.8\% (difference 0.7\%, p < 0.001), with hyperkalemia associated with death reported in 2 (0.05\%) candesartan patients and 1 (0.03\%) placebo patient. The benefit of candesartan in reducing cardiovascular death or heart failure hospitalization (relative risk reduction 16\%, p < 0.0001) was uniform in these subgroups, as was the incremental risk of hyperkalemia. ConclusionsThe risk of hyperkalemia is increased in symptomatic heart failure patients with advanced age, male gender, baseline hyperkalemia, renal failure, diabetes, or combined RAAS blockade. Although these groups derive incremental clinical benefit from candesartan, careful surveillance of serum potassium and creatinine is particularly important. 10.1016/j.jacc.2007.07.067}, author = {Desai, Akshay S. and Swedberg, Karl and Mcmurray, John J. V. and Granger, Christopher B. and Yusuf, Salim and Young, James B. and Dunlap, Mark E. and Solomon, Scott D. and Hainer, James W. and Olofsson, Bertil and Michelson, Eric L. and Pfeffer, Marc A. and on behalf of the CHARM Program Investigators}, citeulike-article-id = {5418012}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.jacc.2007.07.067}, citeulike-linkout-1 = {http://content.onlinejacc.org/cgi/content/abstract/50/20/1959}, day = {13}, doi = {10.1016/j.jacc.2007.07.067}, journal = {J Am Coll Cardiol}, keywords = {aldosteron, diuretics, heart-failure}, month = {November}, number = {20}, pages = {1959--1966}, posted-at = {2009-08-11 20:59:35}, priority = {2}, title = {Incidence and Predictors of Hyperkalemia in Patients With Heart Failure: An Analysis of the CHARM Program}, url = {http://dx.doi.org/10.1016/j.jacc.2007.07.067}, volume = {50}, year = {2007} }

TY - JOUR ID - citeulike:5418012 L3 - citeulike-article-id:5418012 N2 - ObjectivesWe explored the incidence and predictors of hyperkalemia in a broad population of heart failure patients. BackgroundWhen used in optimal doses to treat patients with heart failure, renin-angiotensin-aldosterone system (RAAS) inhibitors improve clinical outcomes but can cause hyperkalemia. MethodsParticipants in the CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity) (n = 7,599) Program were randomized to standard heart failure therapy plus candesartan or placebo, titrated as tolerated to a target of 32 mg once daily with recommended monitoring of serum potassium and creatinine. We assessed the incidence and predictors of hyperkalemia associated with dose reduction, study drug discontinuation, hospitalization, or death over the median 3.2 years of follow-up. ResultsIndependent of treatment assignment, the risk of hyperkalemia increased with age [≥]75 years, male gender, diabetes, creatinine [≥]2.0 mg/dl, K+ [≥]5.0 mmol/l, and background use of angiotensin-converting enzyme inhibitors or spironolactone. Candesartan increased the rate of aggregate hyperkalemia from 1.8% to 5.2% (difference 3.4%, p < 0.0001) and serious hyperkalemia (associated with death or hospitalization) from 1.1% to 1.8% (difference 0.7%, p < 0.001), with hyperkalemia associated with death reported in 2 (0.05%) candesartan patients and 1 (0.03%) placebo patient. The benefit of candesartan in reducing cardiovascular death or heart failure hospitalization (relative risk reduction 16%, p < 0.0001) was uniform in these subgroups, as was the incremental risk of hyperkalemia. ConclusionsThe risk of hyperkalemia is increased in symptomatic heart failure patients with advanced age, male gender, baseline hyperkalemia, renal failure, diabetes, or combined RAAS blockade. Although these groups derive incremental clinical benefit from candesartan, careful surveillance of serum potassium and creatinine is particularly important. 10.1016/j.jacc.2007.07.067 IS - 20 JF - J Am Coll Cardiol EP - 1966 TI - Incidence and Predictors of Hyperkalemia in Patients With Heart Failure: An Analysis of the CHARM Program VL - 50 SP - 1959 KW - aldosteron KW - diuretics KW - heart-failure AU - Desai, Akshay AU - Swedberg, Karl AU - Mcmurray, John AU - Granger, Christopher AU - Yusuf, Salim AU - Young, James AU - Dunlap, Mark AU - Solomon, Scott AU - Hainer, James AU - Olofsson, Bertil AU - Michelson, Eric AU - Pfeffer, Marc AU - on behalf of the CHARM Program Investigators PY - 2007/11/13/ UR - http://dx.doi.org/10.1016/j.jacc.2007.07.067 ER -