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Hyperkalemia in Heart Failure with Reduced Ejection Fraction: Implications and Management
Craig J Beavers1, Stephen J Greene2,3
1University of Kentucky College of Pharmacy, Lexington, KY, USA. craig.beaverspharmd@gmail.com.
Heart Failure Reviews
|August 22, 2025
Summary
Hyperkalemia management in heart failure (HF) is crucial for optimal treatment. New therapies and monitoring strategies help manage high potassium levels, allowing continued use of life-saving heart failure medications.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Hyperkalemia poses a significant challenge in managing heart failure (HF).
- Guideline-directed medical therapies (GDMT) for HF, including renin-angiotensin-aldosterone system inhibitors (RAASi) and steroidal mineralocorticoid receptor antagonists (sMRAs), are limited by hyperkalemia risk.
- Hyperkalemia is more prevalent in HF patients, especially those with chronic kidney disease (CKD) and diabetes mellitus.
Purpose of the Study:
- To review the complex relationship between hyperkalemia and GDMT in heart failure.
- To discuss the implications of hyperkalemia on HF treatment adherence and patient outcomes.
- To highlight emerging strategies for managing hyperkalemia in HF patients.
Main Methods:
- Literature review synthesizing current evidence on hyperkalemia in HF.
- Analysis of the impact of RAASi and MRA therapies on potassium levels.
- Evaluation of novel therapeutic approaches and monitoring techniques.
Main Results:
- Hyperkalemia frequently restricts the use of beneficial HF therapies.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors may reduce hyperkalemia risk when combined with RAASi.
- Non-steroidal MRAs (nsMRAs) like finerenone and potassium binders (patiromer, SZC) offer new management options.
Conclusions:
- Effective hyperkalemia management is essential for optimizing GDMT in HF.
- Regular potassium monitoring and proactive interventions are key.
- Emerging therapies and agents like nsMRAs and potassium binders improve treatment tolerance and outcomes.
Keywords:
AntagonistsCardiovascular outcomesChronic kidney diseaseDrug-induced hyperkalemiaFinerenoneGuideline-directed medical therapy (GDMT)Heart failureHyperkalemiaMineralocorticoid receptorPotassium bindersPotassium homeostasisRAAS inhibitorsSGLT2 inhibitorsMore Related Videos
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