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Hyperkalemia in Heart Failure with Reduced Ejection Fraction Patients Treated with Sacubitril/Valsartan: Experience

Sarah M Alyousif1,2, Naif K Alaqil2,3, Mohamad Abdelshafy1,2

  • 1King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 14611, Saudi Arabia.

Clinics and Practice
|October 28, 2025
PubMed

Insights

Sacubitril/valsartan use in heart failure with reduced ejection fraction (HFrEF) increases hyperkalemia risk. However, hyperkalemia was manageable, with low discontinuation rates, indicating the therapy is generally safe for HFrEF patients.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart failure with reduced ejection fraction (HFrEF) is a significant global health issue.
  • Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), is effective for HFrEF but associated with hyperkalemia risk.

Purpose of the Study:

  • To evaluate the incidence of hyperkalemia in HFrEF patients treated with sacubitril/valsartan.
  • To assess treatment discontinuation rates due to hyperkalemia.

Main Methods:

  • A retrospective cohort study of 238 HFrEF patients initiated on sacubitril/valsartan.
  • Potassium levels monitored pre-initiation and at 0-3, 3-6, and 6-12 months post-initiation.
  • Hyperkalemia defined as potassium levels >5.0, >5.5, and >6.0 mmol/L.

Main Results:

  • Hyperkalemia >5.0 mmol/L increased significantly from 8.2% pre-initiation to 44.4% within three months post-initiation (p < 0.0001).
  • Only 17.3% of patients exceeded 5.5 mmol/L.
  • Treatment discontinuation occurred in 7.1% of patients, with only 1.3% due to hyperkalemia.

Conclusions:

  • Sacubitril/valsartan therapy leads to a higher incidence of hyperkalemia in HFrEF patients.
  • Hyperkalemia is generally manageable, with low discontinuation rates, supporting the therapy's safety and efficacy.
  • Prospective studies with regular electrolyte monitoring are recommended to further validate findings.

Keywords:
heart failure with reduced ejection fractionhyperkalemiasacubitril/valsartan

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