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Circulation. 2018 Mar 27;137(13):1320-1330. doi: 10.1161/CIRCULATIONAHA.117.030576. Epub 2017 Oct 12.

Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality.

Author information

1
Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.) yulnunez@gmail.com.
2
CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., A.B.-G., G.M., A.M., J.L., J.S.).
3
Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and Department of Medicine, Autonomous University of Barcelona, Spain (A.B.-G., J.L.).
4
Inserm, Centre d'Investigation Clinique Plurithématique 1433, Inserm U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, France (F.Z., P.R.).
5
Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.).
6
Biochemistry Department, Hospital Clínico Universitario de Valencia, INCLIVA, Spain (A.C.).
7
Hospital Clínico Universitario, Universitat de València, INCLIVA, Spain. CIBERESP (J.N.).
8
Nephrology Department, Hospital Clínico Universitario, INCLIVA, Department of Medicine, Universitat de València, Spain (J.L.G.).
9
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Germany (O.H.).
10
Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.M.).

Abstract

BACKGROUND:

The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission.

METHODS:

Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling.

RESULTS:

The study sample included 2164 patients with a total of 16 116 potassium observations. Mean potassium at discharge was 4.3±0.48 mEq/L. Hypokalemia (<3.5 mEq/L), normokalemia (3.5-5.0 mEq/L), and hyperkalemia (>5 mEq/L) were observed at the index admission in 77 (3.6%), 1965 (90.8%), and 122 (5.6%) patients, respectively. At a median follow-up of 2.8 years (range, 0.03-12.8 years), 1090 patients died (50.4%). On a continuous scale, the multivariable-adjusted association of potassium values and mortality revealed a nonlinear association (U-shaped) with higher risk at both ends of its distribution (omnibus P=0.001). Likewise, the adjusted hazard ratios for hypokalemia and hyperkalemia, normokalemia as reference, were 2.35 (95% confidence interval, 1.40-3.93; P=0.001) and 1.55 (95% confidence interval, 1.11-2.16; P=0.011), respectively (omnibus P=0.0003). Furthermore, dynamic changes in potassium were independently associated with substantial differences in mortality risk. Potassium normalization was independently associated with lower mortality risk (P=0.001).

CONCLUSIONS:

Either modeled continuously or categorically, serum potassium levels during long-term monitoring were independently associated with mortality in patients with heart failure. Likewise, persistence of abnormal potassium levels was linked to a higher risk of death in comparison with patients who maintained or returned to normal values.

KEYWORDS:

cohort studies; heart failure; hyperkalemia; hypokalemia; longitudinal studies; mortality; potassium

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