Management of Serum Potassium  in Patients with Heart Failure

Bertram Pitt; Orly Vardeny; George Bakris

Management of Serum Potassium  in Patients with Heart Failure

Moderator:

Bertram Pitt, MD

University of Michigan School of Medicine

Discussants:

Date: July 16, 2012

Roundtable ID: CV11987

Citation: Med Roundtable Cardiovasc Ed. ; 3(3): 190 - 196.

Summary:
Dr. Bertram Pitt from the University of Michigan School of Medicine, Ann Arbor, MI moderated the topic "Management of Serum Potassium in Patients with Heart Failure" with Drs. George Bakris from the University of Chicago Medicine, Chicago, Il, and Orly Vardeny from the University of Wisconsin, Madison, WI.

The discussion focused primarily on:

(1) The diagnosis of hyperkalemia using potassium levels: biases and laboratory settings

(2) monitoring potassium levels in patients with renal disease and the use of dietary or pharmacologic interventions

(3) risk factors that predispose patients to hyperkalemia

(4) the frequency of hyperkalemia in heart failure and the role of multiple renin-angiotensin system (RAS) inhibitors

(5) recommendations for the frequency of monitoring in patients who take multiple RAS inhibitors

(6) the physicians role in counseling patients on avoiding high-potassium diets

(7) treatment considerations for a patient diagnosed with hyperkalemia

(8) recommended pharmacologic options and the use of dialysis.

(Med Roundtable Cardiovasc Ed. 2012;3(3):190–196) ©2012 FoxP2Media, LLC

Compounds:
eplerenone, spironolactone, sodium polystyrene sulfonate, minoxidil, furosemide, metolazone

Trials:
RALES, EMPHASIS-HF, RENAAL

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"The difference in clinical practice is that individuals may not be as stringent at monitoring, and so I think hyperkalemia gets captured potentially a lot sooner in clinical trials as opposed to in clinical practice."
Orly Vardeny, PharmD

"Salt substitute is potassium chloride, so if a patient with stage 3 CKD estimated GFR <60 mL/min/1.73 m2 uses it regularly, it can be dangerous. This should be part of the warning that patients get, along with the consumption of certain foods."
George Bakris, MD

"One of the attractive things about the aldosterone story … is that people who have hypokalemia often have hypomagnesemia, and when you give an aldosterone blocker, you’re correcting tissue stores of both potassium and magnesium."
Bertram Pitt, MD

Management of Serum Potassium in Patients with Heart Failure

Moderator:

Discussants:

Management of Serum Potassium  in Patients with Heart Failure