心力衰竭伴射血分数降低的高钾血症:影响和处理。

IF 4.2 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Craig J Beavers, Stephen J Greene
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引用次数: 0

摘要

高钾血症是一种潜在危及生命的电解质失衡,传统上对心力衰竭(HF)的治疗提出了重大挑战。本综述探讨了高钾血症与使用指南导向药物治疗(GDMT)之间的复杂相互作用,如肾素-血管紧张素-醛固酮系统抑制剂(RAASi)和甾体矿皮质激素受体拮抗剂(sMRAs),包括螺内酯和埃普利酮,目前在指南中推荐用于改善心力衰竭的预后并降低射血分数(HFrEF)。虽然这些疗法降低了HFrEF患者的死亡率和住院率,但它们对左室射血分数(LVEF)≥40%的心力衰竭患者的益处仍不确定。然而,它们在临床实践中的使用往往受到高钾血症风险的限制,可能导致剂量减少或停止挽救生命的治疗。与普通人群相比,心衰患者高钾血症的患病率明显更高,特别是那些合并慢性肾脏疾病(CKD)和糖尿病的患者,这进一步使治疗复杂化。本综述强调了定期钾监测的重要性,钠-葡萄糖共转运蛋白2 (SGLT2)抑制剂与RAASi联合治疗降低高钾血症风险的潜在益处,以及新出现的非甾体MRA (nsMRA),芬烯酮,可能具有较低的高钾血症风险。此外,钾结合剂如帕特罗默和环硅酸锆钠(SZC)因其在管理和预防高钾血症中的作用而被强调,使患者能够不间断地继续最佳的RAASi和MRA治疗。通过综合目前关于心衰患者高钾血症的发病率、风险和管理策略的证据,本综述旨在为临床医生提供一个全面的指导,以优化患者的预后,同时减轻高钾血症相关的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hyperkalemia in Heart Failure with Reduced Ejection Fraction: Implications and Management.

Hyperkalemia is a potentially life-threatening electrolyte imbalance that has traditionally posed significant challenges in the management of heart failure (HF). This review explores the complex interplay between hyperkalemia and the use of guideline-directed medical therapies (GDMT), such as renin-angiotensin-aldosterone system inhibitors (RAASi) and steroidal mineralocorticoid receptor antagonists (sMRAs), including spironolactone and eplerenone, which are currently recommended in guidelines for improving outcomes in heart failure with reduced ejection fraction (HFrEF). While these therapies reduce mortality and hospitalizations in HFrEF, their benefit in patients with heart failure with left ventricular ejection fraction (LVEF) ≥ 40% remains less conclusive. Nevertheless, their use in clinical practice is often limited by the risk of hyperkalemia, potentially leading to dose reduction or discontinuation of life-saving treatments. The prevalence of hyperkalemia in HF patients is notably higher compared to the general population, particularly in those with comorbid chronic kidney disease (CKD) and diabetes mellitus, further complicating management. This review emphasizes the importance of regular potassium monitoring, the potential benefits of combining therapies such as sodium-glucose cotransporter 2 (SGLT2) inhibitors with RAASi to reduce the risk of hyperkalemia, and the emergence of the newer non-steroidal MRA (nsMRA), finerenone, which may have a lower risk of hyperkalemia. Additionally, potassium binders such as patiromer and sodium zirconium cyclosilicate (SZC) are highlighted for their role in managing and preventing hyperkalemia, allowing patients to continue optimal RAASi and MRA therapy without interruption. By synthesizing current evidence on the incidence, risks, and management strategies of hyperkalemia in HF, this review aims to provide a comprehensive guide for clinicians to optimize patient outcomes while mitigating the risks associated with hyperkalemia.

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来源期刊
Heart Failure Reviews
Heart Failure Reviews 医学-心血管系统
CiteScore
10.40
自引率
2.20%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.
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