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Empagliflozin and serum potassium in heart failure: an analysis from EMPEROR-Pooled( )

AIMS: Hyperkalaemia frequently leads to interruption and discontinuation of neurohormonal antagonists, which may worsen heart failure prognosis. Some studies suggested that sodium-glucose cotransporter 2 inhibitors reduce hyperkalaemia, an effect that may have important clinical implications. This a...

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Autores principales: Ferreira, João Pedro, Zannad, Faiez, Butler, Javed, Filipattos, Gerasimos, Ritter, Ivana, Schüler, Elke, Kraus, Bettina J, Pocock, Stuart J, Anker, Stefan D, Packer, Milton
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375711/
https://www.ncbi.nlm.nih.gov/pubmed/35687107
http://dx.doi.org/10.1093/eurheartj/ehac306
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author Ferreira, João Pedro
Zannad, Faiez
Butler, Javed
Filipattos, Gerasimos
Ritter, Ivana
Schüler, Elke
Kraus, Bettina J
Pocock, Stuart J
Anker, Stefan D
Packer, Milton
author_facet Ferreira, João Pedro
Zannad, Faiez
Butler, Javed
Filipattos, Gerasimos
Ritter, Ivana
Schüler, Elke
Kraus, Bettina J
Pocock, Stuart J
Anker, Stefan D
Packer, Milton
author_sort Ferreira, João Pedro
collection PubMed
description AIMS: Hyperkalaemia frequently leads to interruption and discontinuation of neurohormonal antagonists, which may worsen heart failure prognosis. Some studies suggested that sodium-glucose cotransporter 2 inhibitors reduce hyperkalaemia, an effect that may have important clinical implications. This analysis evaluates the effect of empagliflozin on the occurrence of hyper- and hypokalaemia in HF. METHODS AND RESULTS: EMPEROR-Pooled (i.e. EMPEROR-Reduced and EMPEROR-Preserved combined) included 9583 patients with available serum potassium levels at baseline (98.6% of the total EMPEROR-Pooled population, n = 9718). Hyperkalaemia was identified by investigators’ reports of adverse events, and by a laboratory serum potassium value above 5.5 mmol/L and 6.0 mmol/L. The main outcome was a composite of investigator-reported hyperkalaemia or initiation of potassium binders. Patients with high potassium at baseline were more frequently diagnosed with diabetes and ischaemic HF aetiology and had lower left ventricular ejection fraction and estimated glomerular filtration rate but were more frequently treated with sacubitril/valsartan or mineralocorticoid receptor antagonists. Empagliflozin (compared with placebo) reduced the composite of investigator-reported hyperkalaemia or initiation of potassium binders [6.5% vs. 7.7%, hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.71–0.95, P = 0.01]. Empagliflozin reduced hyperkalaemia rates regardless of the definition used (serum potassium >5.5 mmol/l: 8.6% vs. 9.9%, HR 0.85, 95% CI 0.74–0.97, P = 0.017; serum potassium >6.0 mmol/l: 1.9% vs. 2.9%, HR 0.62, 95% CI 0.48–0.81, P < 0.001). The incidence of hypokalaemia (investigator-reported or serum potassium <3.0 mmol/l) was not significantly increased with empagliflozin. CONCLUSIONS: Empagliflozin reduced the incidence of hyperkalaemia without significant increase in hypokalaemia.
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spelling pubmed-93757112022-08-15 Empagliflozin and serum potassium in heart failure: an analysis from EMPEROR-Pooled( ) Ferreira, João Pedro Zannad, Faiez Butler, Javed Filipattos, Gerasimos Ritter, Ivana Schüler, Elke Kraus, Bettina J Pocock, Stuart J Anker, Stefan D Packer, Milton Eur Heart J Clinical Research AIMS: Hyperkalaemia frequently leads to interruption and discontinuation of neurohormonal antagonists, which may worsen heart failure prognosis. Some studies suggested that sodium-glucose cotransporter 2 inhibitors reduce hyperkalaemia, an effect that may have important clinical implications. This analysis evaluates the effect of empagliflozin on the occurrence of hyper- and hypokalaemia in HF. METHODS AND RESULTS: EMPEROR-Pooled (i.e. EMPEROR-Reduced and EMPEROR-Preserved combined) included 9583 patients with available serum potassium levels at baseline (98.6% of the total EMPEROR-Pooled population, n = 9718). Hyperkalaemia was identified by investigators’ reports of adverse events, and by a laboratory serum potassium value above 5.5 mmol/L and 6.0 mmol/L. The main outcome was a composite of investigator-reported hyperkalaemia or initiation of potassium binders. Patients with high potassium at baseline were more frequently diagnosed with diabetes and ischaemic HF aetiology and had lower left ventricular ejection fraction and estimated glomerular filtration rate but were more frequently treated with sacubitril/valsartan or mineralocorticoid receptor antagonists. Empagliflozin (compared with placebo) reduced the composite of investigator-reported hyperkalaemia or initiation of potassium binders [6.5% vs. 7.7%, hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.71–0.95, P = 0.01]. Empagliflozin reduced hyperkalaemia rates regardless of the definition used (serum potassium >5.5 mmol/l: 8.6% vs. 9.9%, HR 0.85, 95% CI 0.74–0.97, P = 0.017; serum potassium >6.0 mmol/l: 1.9% vs. 2.9%, HR 0.62, 95% CI 0.48–0.81, P < 0.001). The incidence of hypokalaemia (investigator-reported or serum potassium <3.0 mmol/l) was not significantly increased with empagliflozin. CONCLUSIONS: Empagliflozin reduced the incidence of hyperkalaemia without significant increase in hypokalaemia. Oxford University Press 2022-06-10 /pmc/articles/PMC9375711/ /pubmed/35687107 http://dx.doi.org/10.1093/eurheartj/ehac306 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research
Ferreira, João Pedro
Zannad, Faiez
Butler, Javed
Filipattos, Gerasimos
Ritter, Ivana
Schüler, Elke
Kraus, Bettina J
Pocock, Stuart J
Anker, Stefan D
Packer, Milton
Empagliflozin and serum potassium in heart failure: an analysis from EMPEROR-Pooled( )
title Empagliflozin and serum potassium in heart failure: an analysis from EMPEROR-Pooled( )
title_full Empagliflozin and serum potassium in heart failure: an analysis from EMPEROR-Pooled( )
title_fullStr Empagliflozin and serum potassium in heart failure: an analysis from EMPEROR-Pooled( )
title_full_unstemmed Empagliflozin and serum potassium in heart failure: an analysis from EMPEROR-Pooled( )
title_short Empagliflozin and serum potassium in heart failure: an analysis from EMPEROR-Pooled( )
title_sort empagliflozin and serum potassium in heart failure: an analysis from emperor-pooled( )
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375711/
https://www.ncbi.nlm.nih.gov/pubmed/35687107
http://dx.doi.org/10.1093/eurheartj/ehac306
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