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Moderate potassium lowering effect of exogenous atrial natriuretic peptide in patients with acute heart failure
Masaaki Konishi1, Eiichi Akiyama2, Atsushi Shibata3
1Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Insights
Exogenous atrial natriuretic peptide (ANP) treatment in heart failure (HF) patients lowered serum potassium levels, correlating with urine volume. Hypokalemia risk was minimal, except when combined with higher furosemide doses.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Recent data suggest angiotensin receptor neprilysin inhibitors modulate natriuretic peptides and reduce hyperkalemia risk in heart failure (HF).
- The specific impact of natriuretic peptides on serum electrolyte balance, particularly sodium and potassium, in HF patients remains incompletely understood.
- This study investigates the effects of exogenous atrial natriuretic peptide (ANP) on electrolyte levels in acute HF.
Purpose of the Study:
- To analyze the impact of intravenous carperitide (an exogenous ANP) on serum sodium and potassium levels in patients with acute heart failure.
- To determine the relationship between carperitide dosage, urine volume, and changes in serum electrolytes.
- To assess the risk of electrolyte abnormalities, specifically hypokalemia, during ANP treatment in HF.
Main Methods:
- Post-hoc analysis of a multicenter prospective cohort study involving 162 patients with acute HF.
- Patients were treated with intravenous carperitide, either alone or in combination with furosemide.
- Serum electrolytes (sodium, potassium) and urine volume were monitored during the initial 48 hours of treatment.
Main Results:
- Carperitide administration demonstrated a significant diuretic effect, correlating with increased urine volume.
- Serum sodium levels remained stable in both carperitide-alone and carperitide-plus-furosemide groups.
- Serum potassium levels decreased significantly in both treatment groups, with a notable correlation between urine volume and potassium reduction in the carperitide-alone group.
- The incidence of hypokalemia was higher in patients receiving 20 mg or more of furosemide concurrently.
Conclusions:
- Treatment of acute heart failure with exogenous atrial natriuretic peptide (carperitide) leads to a decrease in serum potassium levels.
- The reduction in potassium is significantly associated with the diuretic effect (urine volume).
- The risk of developing hypokalemia is low with carperitide treatment alone but increases when combined with substantial doses of furosemide.
Abstract:
Background Recent data suggest that the angiotensin receptor neprilysin inhibitor modulates plasma levels of natriuretic peptides and attenuates the risk of hyperkalemia in patients with heart failure (HF). However, the impact of natriuretic peptides on serum electrolyte abnormalities, especially abnormalities in sodium and potassium levels in patients with HF remains unclear. Methods We performed a post-hoc analysis of a multicenter prospective cohort study in 162 patients with acute HF (74.2 ± 13.3 years, 64.2% male, left ventricular ejection fraction 44 ± 15%) treated with intravenous carperitide, an exogenous atrial natriuretic peptide. Results The dose of carperitide was correlated with urine volume (σ = 0.205, p = 0.009), suggesting a significant diuretic effect. During the initial 48 h, serum sodium level remained unchanged both in 53 patients with carperitide alone (from 140 ± 4 to 140 ± 3 mEq/L, p = 0.653) and 109 patients treated with a combination of carperitide and furosemide (141 ± 4 to 141 ± 4 mEq/L, p = 0.644). On the contrary, serum potassium level was decreased both in patients with carperitide alone (from 4.32 ± 0.70 to 4.08 ± 0.47 mEq/L, p = 0.004) and patients treated with a combination of carperitide and furosemide (4.17 ± 0.55 to 3.98 ± 0.47, p < 0.001), with a significant association between urine volume and change in potassium level in patients treated with carperitide alone (σ = -0.313, p = 0.023). The incidence of hypokalemia at 24 h was higher in patients treated with 20 mg furosemide or more (12.5% vs. 2.8%, p = 0.039). Conclusions Serum potassium level decreased after HF treatment with exogenous atrial natriuretic peptide, with a significant correlation to urine volume. The risk of hypokalemia was low, unless treated with additional furosemide.
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