Real or Perceived: Hyperkalemia Is a Major Deterrent for Renin-Angiotensin Aldosterone Svstem Inhibition in Heart Failure

摘要

We are in the midst of a heart failure (HF) pandemic with wide-ranging implications for aging populations, physicians, and healthcare delivery systems [1]. The major epidemiologic determinants for HF have been traditionally viewed as hypertension, coronary artery disease, valvular disease, and more recently obesity, diabetes, and kidney disease [2, 3]. Both the common soil and the clinical outcomes of chronic kidney disease (CKD) and HF are strong mandates for angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARB), and mineralocorticoid receptor antagonists (MRA) in the setting of HF, collectively termed renin-angiotensin aldosterone system (RAAS) inhibition. In this issue of Nephron, Koratala et al. [4] contend that"... RAAS inhibitor discontinuation rate due to hyperkalemia was reported to be as low as 0.1-3.4%, and there was no strong association reported between hyperkalemia and worse outcomes." We believe this conclusion is based on a rather narrow view of the clinical literature on this topic.