Risks from Low Potassium in Heart Failure Patients With Chronic Kidney Disease ScienceDaily (Feb.

23, 2010) In findings reported in January inCirculation: Heart Failure, a journal of the American Heart Association, the researchers say that even a mild decrease in serum potassium level increased the risk of death in this patient group. "Hypokalemia, or low potassium, is common in heart-failure patients and is associated with poor outcomes, as is chronic kidney disease," said C. Barrett Bowling, M.D., a fellow in the UAB Division of Gerontology, Geriatrics and Palliative Care. "But little is known about the prevalence and effect of hypokalemia in heart-failure patients who also have CKD." Bowling, a graduate of the UAB Internal Medicine residency program, said these findings indicate that in patients with heart failure and CKD the serum potassium levels should be monitored routinely and carefully maintained within a safe range. The UAB researchers studied data from 1,044 patients with heart failure and CKD in the Digitalis Investigation Group study, sponsored by the National Heart, Lung and Blood Institute, one of the National Institutes of Health. Normal potassium levels were expressed at between 4 and 4.9 mEq/L. Mild hypokalemia was defined as between 3.5 to 3.9 mEq/L and low hypokalemia as below 3.5 mEq/L. Death occurred in 48 percent of the patients with hypokalemia during the 57-month follow-up period, compared with only 36 percent of patients with normal potassium. The vast majority of subjects, 87 percent, had mild hypokalemia. Hospitalization also was slightly higher for subjects with low potassium, 59 percent compared with 53 percent for those with normal potassium levels. "It has long been considered that high potassium levels were more common in heartfailure patients with CKD," said Ali Ahmed, M.D., senior author of the study and associate professor of medicine in the Divisions of Gerontology, Geriatrics and Palliative Care and Cardiovascular Disease. "Our findings indicate that low potassium may be even more common in these patients, and clinicians need to be aware of the risks associated with even mildly low potassium levels and monitor and treat their patients accordingly." Others from UAB involved in the study are Mustafa I. Ahmed, M.D.; Inmaculada B. Aban, Ph.D.; Paul W. Sanders, M.D.; Marjan Mujib, BS, MPH; Ruth C. Campbell, M.D.; and Richard M. Allman, M.D. Also involved are Bertram Pitt, M.D., University of Michigan at Ann Arbor; Thomas E. Love, Ph.D., Case Western University; Wilbert S. Aronow, M.D., New York Medical College; and George L. Bakris, M.D., University of Chicago.

Summary:

New research from the University of Alabama at Birmingham (UAB) says low potassium levels produce an increased risk of death or hospitalization in patients with heart failure and chronic kidney disease (CKD). Reaction: Hypokalemia is a serious and danger problem when it is severely low because potassium is needed not only in the GI tract but also in the conduction of the heart. It is characterised by low potassium levels in the blood (serum potassium), which increases a patient’s risk of cardiac fibrilation and sudden death. At particular risk are heart failure patients, especially those with an underlying chronic kidney disease being treated with aldosterone antagonists. Although these drugs have shown life-saving benefits in multiple large outcome studies, their use is limited by the occurrence or fear of hypokalemia. In Chronic kidney disease it is associated with high blood pressure, heart
disease, and strokes. Potassium lowers blood pressure and may help prevent heart disease and strokes in the general population, but has not been well-studied in people with kidney disease. This study will look at the benefits and safety of two levels of potassium intake in patients with kidney disease. We expect that a higher level of potassium intake safely lowers blood pressure compared to a lower level of potassium intake. We hope that this and other research projects will help us to learn more so that guidelines can be created for potassium intake in patients with chronic kidney disease as a health care provider we are responsible in teaching patients and treating patients with hypokalemia and kidney disease to prevent Death of patients.

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