Acute heart failure and adverse events associated with the presence of renal dysfunction and hyperkalaemia. EAHFE- renal dysfunction and hyperkalaemia


      • The presence of renal dysfunction and hyperkalemia is common in patients with acute heart failure.
      • The combination of both is associated with more 30-day all-cause mortality.
      • This combination was not related to more in-hospital all-cause mortality.
      • This combination was not related to more 30-day ED reconsultation for HF.



      To study the outcomes of patients with acute heart failure (AHF) presenting renal dysfunction (RD) or hyperkalaemia (Hk) alone or in combination.


      We analysed the data of the EAHFE registry, a multicentre, non interventionist cohort with prospective follow-up of patients with AHF. Four groups were defined based on the presence or not of RD or Hk alone or in combination. The primary endpoint was 30-day all-cause mortality.


      A total of 11,935 of the 13,791 patients included in the EAHFE registry were analysed. Of these, 5088 (42.6%) did not have RD or Hk (NoRD-NoHk), 150 (1.3%) had no RD but had Hk (NoRD-Hk), 6012 (50.4%) had RD but not Hk (RD-NoHk) and 685 (5.7%) had both RD and Hk (RD-Hk). Thirty-day all-cause mortality was greatest in the RD-Hk group with an adjusted Hazard Ratio (HR) of 2.44 (confidence interval 95% [CI95%] 1.67–3.55; p < 0.001) and in the RD-NoHk group with an adjusted HR of 1.34 (CI95% 1.04–1.71; p = 0.022). There were no significant differences in in-hospital mortality and reconsultation at 30 days for HF. For the combined endpoint of 30-day all-cause mortality the adjusted HR was 1.33 (CI95% 1.04–1.70); (p = 0.021) for the RD-Hk group.


      The association of 30-day all-cause mortality with the presence of RD and Hk in patients presenting AHF at admission is greater than in those without this combination.


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        • Delgado J.F.
        • Oliva J.
        • Llano M.
        • Pascual-Figal D.
        • Grillo J.J.
        • Comín-Colet J.
        • et al.
        Health care and nonhealth care costs in the treatment of patients with symptomatic chronic heart failure in Spain.
        Rev Esp Cardiol. 2014; 67: 643-650
        • Llorens P.
        • Javaloyes P.
        • Martín-Sánchez F.J.
        • Jacob J.
        • Herrero-Puente P.
        • Gil V.
        • et al.
        Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure.
        Clin Res Cardiol. 2018; 107: 897-913
        • Cioffi G.
        • Mortara A.
        • Di Lenarda A.
        • Oliva F.
        • Lucci D.
        • Senni M.
        • et al.
        Clinical features,and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian registry IN-HF outcome.
        Int J Cardiol. 2013; 168: 3691-3697
        • Weidmann Z.M.
        • Breidthardt T.
        • Twerenbold R.
        • Zuesli C.
        • Nowak A.
        • EckardsteinA von
        • et al.
        Prediction of mortality using quantification of renal function in acute heart failure.
        Int J Cardiol. 2015; 201: 650-657
        • Hernáez Á.
        • Delgado J.F.
        • Cinca J.
        • Fernández-Avilés F.
        • Marrugat J.
        Prevalence and incidence of hyperkalaemia in the Spanish population with heart failure with reduced ejection fraction: a systematic review and populational relevance.
        Rev Clin Esp. 2018; 218: 253-260
        • Crespo-Leiro M.G.
        • Anker S.D.
        • Maggioni A.P.
        • Coats A.J.
        • Filippatos G.
        • Ruschitzka F.
        • et al.
        European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions.
        Eur J Heart Fail. 2016; 18: 613-625
        • Miró Ò.
        • Rossello X.
        • Gil V.
        • Martín-Sánchez F.J.
        • Llorens P.
        • Herrero-Puente P.
        • et al.
        Predicting 30-day mortality for patients with acute heart failure in the emergency department: a cohort study.
        Ann Intern Med. 2017; 167: 698-705
        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • Bueno H.
        • Cleland J.G.F.
        • Coats A.J.S.
        • et al.
        ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 18 (2016): 891-975
        • Llauger L.
        • Jacob J.
        • Miró Ò.
        Renal function and acute heart failure outcome.
        Med Clin (Barc). 2018; 151: 281-290
        • Jain N.
        • Kotla S.
        • Little B.B.
        • Weideman R.A.
        • Brilakis E.S.
        • Reilly R.F.
        • et al.
        Predictors of hyperkalemia and death in patients with cardiac and renal disease.
        Am J Cardiol. 2012; 109: 1510-1513
        • Llorens P.
        • Escoda R.
        • Miró O.
        • Herrero Puente P.
        • Martín-Sánchez F.J.
        • Jacob J.
        • et al.
        Characteristics and clinical course of patients with acute heart failure and the therapeutic measures applied in Spanish emergency departments: based on the EAHFE registry (Epidemiology of acute heart failure in emergency departments).
        Emergencias. 2015; 27: 11-22
        • Miró O.
        • Llorens P.
        • Escalada X.
        • Herrero P.
        • Jacob J.
        • Gil V.
        • et al.
        Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency medical response systems for patients with acute heart failure).
        Emergencias. 2017; 29: 223-230
        • Llauger L.
        • Jacob J.
        • Corominas Lasalle G.
        • Puig Martorell J.
        • González Casquet P.
        • Bullon Chia A.
        Renal insufficiency and hyperkalemia in acute heart failure.
        Emergencias. 2018; 30: 357-358
        • Ho K.K.
        • Anderson K.M.
        • Kannel W.B.
        • Grossman W.
        • Levy D.
        Survival after the onset of congestive heart failure in Framingham heart study subjects.
        Circulation. 1993; 88: 107-115
        • Juurlink D.N.
        • Mamdani M.M.
        • Lee D.S.
        • Kopp A.
        • Austin P.C.
        • Laupacis A.
        • et al.
        Rates of hyperkalemia after publication of the randomized Aldactone evaluation study.
        N Engl J Med. 2004; 351: 543-551
        • Adams Jr., K.F.
        • Fonarow G.C.
        • Emerman C.L.
        • et al.
        ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE).
        Am Heart J. 2005; 149: 209-216
        • Michel A.
        • Martín-Pérez M.
        • Ruigómez A.
        • García Rodríguez L.A.
        Risk factors for hyperkalaemia in a cohort of patients with newly diagnosed heart failure: a nested case-control study in UK general practice.
        Eur J Heart Fail. 2015; 17: 205-213
        • Llorens P.
        Risk assessment in emergency department patients with acute heart failure: we need to reach beyond our clinical judgment.
        Emergencias. 2018; 30: 75-76
        • Formiga F.
        • Chivite D.
        Acute heart failure: understanding the patient is essential.
        Emergencias. 2018; 30: 145-146
        • Einhorn L.M.
        • Zhan M.
        • Hsu V.D.
        • Walker L.D.
        • Moen M.F.
        • Seliger S.L.
        • et al.
        The frequency of hyperkalemia and its significance in chronic kidney disease.
        Arch Intern Med. 2009; 169: 1156-1162
        • Voors A.A.
        • Davison B.A.
        • Teerlink J.R.
        • Felker G.M.
        • Cotter G.
        • Filippatos G.
        • et al.
        Diuretic response in patients with acute decompensated heart failure: characteristics and clinical outcome-an analysis from RELAX-AHF.
        Eur J Heart Fail. 2014; 16: 1230e1240
        • ter Maaten J.M.
        • Valente M.A.
        • Metra M.
        • Bruno N.
        • O'Connor C.M.
        • Ponikowski P.
        • et al.
        A combined clinical and biomarker approach to predict diuretic response in acute heart failure.
        Clin Res Cardiol. 2016; 105: 145-153
        • Tromp J.
        • Ter Maaten J.M.
        • Damman K.
        • O'Connor C.M.
        • Metra M.
        • Dittrich H.C.
        • et al.
        Serum potassium levels and outcome in acute heart failure (data from the PROTECT and COACH trials).
        Am J Cardiol. 2017; 119: 290-296
        • Weir M.R.
        • Bakris G.L.
        • Bushinsky D.A.
        • Mayo M.R.
        • Garza D.
        • Stasiv Y.
        • et al.
        Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors.
        N Engl J Med. 2015; 372: 211-221
        • Pitt B.
        • Anker S.D.
        • Bushinsky D.A.
        • Kitzman D.W.
        • Zannad F.
        • Huang I.Z.
        • et al.
        Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial.
        Eur Heart J. 2011; 32: 820-825
        • Packham D.K.
        • Rasmussen H.S.
        • Lavin P.T.
        • El-Shahawy M.A.
        • Roger S.D.
        • Block G.
        • et al.
        Sodium zirconium cyclosilicate in hyperkalemia.
        N Engl J Med. 2015; 372: 222-231
        • Das S.
        • Dey J.K.
        • Sen S.
        • Mukherjee R.
        Efficacy and safety of Patiromer in Hyperkalemia: a systematic review and meta-analysis.
        J Pharm Pract. 2018; 31: 6-17
        • Mahoney B.A.
        • Smith W.A.
        • Lo D.
        • Tsoi K.
        • Tonelli M.
        • Clase C.
        Emergency interventions for hyperkalaemia.
        Cochrane Database Syst Rev. 2005; CD003235