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Journal of the Union of Scientists - Varna. Medicine and Ecology Series

Risk of hyperkalemia in heart failure patients and new treatment approaches

Nadezhda Hvarchanova, Marieta Georgieva, Branimir Kanazirev



Hyperkalemia is a serious medical condition that can cause muscle weakness, paralysis and cardiac arrhythmias. In heart failure (HF), hyperkalemia is a frequent problem, because of several factors, such as chronic kidney disease (CKD), and because of medications, used to treat HF - angiotensin-converting enzyme inhibitors (ACEi)/Angiotensin II receptor blockers (ARBs) and mineralocorticoid receptor inhibitors (MRIs) that increase the serum potassium level, leading to a risk of hyperkalemia.

Materials and Methods

This is a retrospective study.  The risk factors, leading to hyperkalemia among 535 patients, hospitalized for HF at the St. Marina University Hospital in Varna in the period January 2010 - December 2014 were analyzed.


Significant part of the patients with HF have CKD as a comorbidity (56.3%), but they are treated with ACEi/ARBs (70.8%) and MRIs (34.2%), taking medications that increase the serum potassium level, leading to a risk of hyperkalemia. There are also a few patients per year (2.2%) who have hyperkalemia as a comorbidity, but they also must be treated with the same medications- ACEi/ARBs (91.7%) and MRIs (8.3%).


Two new potassium binders - patiromer and sodium zirconium cyclosilicate, are included in the current guidelines (2016) as medications under consideration for regulatory approval. They are new therapeutic options for managing hyperkalemia in patients with HF and a risk of hyperkalemia. The current study reveals the importance of minimizing this adverse effect in order to provide optimal pharmacological treatment for patients with HF.


hyperkalemia, heart failure, renin-angiotensin-aldosterone system inhibitors, chronic kidney disease

Full Text


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