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 heart-
failure 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.