Abstract 16984: Low Left Ventircular Contractile Capacity and Low eGFR Are Significant Predictors for Hyperkalemia in 364 Patients with Heart Failure

Abstract

Background: Randomized Aldactone Evaluation Study (RALES) established the safety of and benefit of spironolactone for heart failure (HF) patients. However, recent data have raised concerns regarding hyperkalemia secondary to spironolactone use and suggest it occurs commonly in routine practice.

Methods: We explored factors potentially associated with hyperkalemia (K>=5.0mmol/L) in a hospital-database of 364 HF patients (Male 50%, 73±14 years, range 34-101).

Results: Patients showed hyperkalemia in 13.4% (n=48), used spironolactone in 49%, and had creatinine (1.16±0.58, 0.50-4.28 mg/dL),baseline K (4.19±0.43, 2.8-5.7 mmol/L),eGFR (52±23, 5-136 ml/min/m2),and left ventricular ejection fraction (LVEF) (54±17%, 12-89%). Odds ratio for hyperkalemia were age>65yo (1.73), male gender (1.15, ns), eGFR<60(ml/min/m2) (7.36, p<0.0001), use of spironolactone (2.63, p=0.003), use of angiotensin converting enzyme inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) (1.08), diabetes mellitus (1.14), and LVEF<50%(3.40, p=0.0002). Predictors for hyperkalemia calculated by multiple regression analysis were eGFR (ml/min/m2) (t ratio 4.88, p<0.0001), LVEF% (t ratio 2.89, p=0.004) and baseline K (2.36, p=0.019). Age, male gender, proteinuria, diabetes, use of neither ACEI/ARB nor spironolactone were not predictors.

Conclusion: Spironolactone was often prescribed to inappropriate HF candidates because of the presence of relative or absolute contraindications. Our findings highlight the need for careful patient selection when prescribing spironolactone especially to patients with low eGFR/LV systolic dysfunction to minimize potential life-threatening hyperkalemia.