Hyperkalemia in Heart Failure

Chaudhry M.S. Sarwar, Lampros Papadimitriou, Bertram Pitt, Ileana Piña, Faiez Zannad, Stefan D. Anker, Mihai Gheorghiade, Javed Butler

Research output: Contribution to journalReview articlepeer-review

74 Scopus citations


Disorders of potassium homeostasis can potentiate the already elevated risk of arrhythmia in heart failure. Heart failure patients have a high prevalence of chronic kidney disease, which further heightens the risk of hyperkalemia, especially when renin-angiotensin-aldosterone system inhibitors are used. Acute treatment for hyperkalemia may not be tolerated in the long term. Recent data for patiromer and sodium zirconium cyclosilicate, used to treat and prevent high serum potassium levels on a more chronic basis, have sparked interest in the treatment of hyperkalemia, as well as the potential use of renin-angiotensin-aldosterone system inhibitors in patients who were previously unable to take these drugs or tolerated only low doses. This review discusses the epidemiology, pathophysiology, and outcomes of hyperkalemia in heart failure; provides an overview of traditional and novel ways to approach management of hyperkalemia; and discusses the need for further research to optimally treat heart failure.

Original languageEnglish (US)
Pages (from-to)1575-1589
Number of pages15
JournalJournal of the American College of Cardiology
Issue number14
StatePublished - Oct 4 2016


  • angiotensin-converting enzyme inhibitors
  • angiotensin-receptor blockers
  • chronic kidney disease
  • mineralocorticoid receptor antagonist
  • patiromer
  • sodium zirconium cyclosilicate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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