Dados do Trabalho

Título

SAFETY AND EFFICACY OF NEW POTASSIUM BINDERS ON HYPERKALEMIA MANAGEMENT IN PATIENTS WITH HEART FAILURE: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Introdução

Background: Hyperkalemia leads to suboptimal use of evidence-based therapies in patients with heart failure (HF). Whether new potassium binders are effective and safe to promote medical optimization in patients with HF is uncertain.

Objetivos

Objective: To assess the benefits and potential harms of new potassium binders for the management of serum potassium levels in patients with HF with hyperkalemia or at risk of hyperkalemia development.

Delineamento e Métodos

Methods: MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after initiation of Patiromer or Sodium Zirconium Cyclosilicate (SZC) versus placebo in patients with HF at high risk of hyperkalemia development. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations.

Resultados

Results: Six RCTs including 1,432 patients were identified, being 737 (51.5%) patients in the potassium binders group. In patients with HF, potassium binders increase rates of treatment optimization with renin-angiotensin-aldosterone inhibitors (RAASi) (RR 1.15; 95% CI 1.02-1.30; p=0.03; I2=53%), reduce the risk of hyperkalemia (RR 0.58; 95% CI 0.40-0.83; p=0.003;I2=46%), but also increase the risk of hypokalemia (RR 2.73; 95% CI 1.18-6.35; p=0.02;I2=0%). There was no difference between groups in mortality rates (RR 1.16; 95% CI 0.65-2.08; p=0.61; I2=0%) and in adverse events (RR 1.04; 95% CI 0.88-1.22; p=0.67; I2=39%).

Conclusões

Conclusion: In this pooled analysis of 6 RCTs with more than 1,400 patients with HF, potassium binders increased rates of medical therapy optimization and reduce the incidence of hyperkalemia. On the other hand, hypokalemia also increased with potassium binders’ treatment.

Palavras Chave

insuficiência cardíaca, hipercalemia, quelantes de potássio, patiromer, SZC