IMR Press / RCM / Volume 24 / Issue 8 / DOI: 10.31083/j.rcm2408228
Open Access Original Research
Serum Potassium Levels and Mortality in Hospitalized Heart Failure Patients
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1 Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), 100037 Beijing, China
2 Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, 100037 Beijing, China
*Correspondence: yuhuizhangjoy@163.com (Yu-Hui Zhang); fwzhangjian62@126.com (Jian Zhang)
Rev. Cardiovasc. Med. 2023, 24(8), 228; https://doi.org/10.31083/j.rcm2408228
Submitted: 8 March 2023 | Revised: 7 April 2023 | Accepted: 24 April 2023 | Published: 9 August 2023
(This article belongs to the Special Issue Congestive Heart Failure)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: To assess the link between serum potassium (K+) and all-cause mortality in hospitalized heart failure (HF) patients. Methods: Hospitalized HF patients (n = 3114) were analyzed at the Fuwai Hospital Heart Failure Center. Before discharge, HF patients were divided into four groups according to the K+ level quartiles: K+ 3.96 mmol/L (Q1), 3.96 < K+ 4.22 mmol/L (Q2), 4.22 < K+ 4.52 mmol/L (Q3), and K+ >4.52 mmol/L (Q4). At 90 days, 2 years, and maximal follow-up, all-cause mortality was the primary outcome. Results: Patients with HF in the Q4 group had worse cardiac function, higher N-terminal pro-B-type natriuretic peptide levels, lower left ventricular ejection fractions and lower estimated glomerular filtration rates than patients in the Q2 group. In the multivariate-adjusted Cox analysis, the mortality assessed during the 90-day, 2-year, and maximal follow-up examinations increased in the Q4 group of HF patients but not in the Q1 and Q3 groups. The Q4 group had a 28% (hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 1.09–1.49, p = 0.002) higher risk of all-cause mortality at maximum follow-up. Hypokalemia and hyperkalemia were linked to increased HF mortality risk at the 90-day, 2-year, and maximal follow-up periods. Conclusions: Serum K+ levels had a J-shaped association with all-cause mortality in HF patients. Both hypokalemia and a K+ level of >4.52 mmol/L were associated with increased all-cause mortality in the short term and long term, suggesting a narrow target K+ range in HF patients. Clinical Trial Registration: Unique Identifier: NCT02664818; URL: ClinicalTrials.gov.

Keywords
serum potassium
heart failure
outcome
hypokalemia
hyperkalemia
Funding
2017YFC1308300/Key Projects in the National Science and Technology Pillar Program of the 13th Five-Year Plan Period
2011BAI11B08/Key Projects in the National Science and Technology Pillar Program of the 12th Five-Year Plan Period
2020-I2M-1-002/CAMS Innovation Fund for Medical Science
Figures
Fig. 1.
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