Management of hyperkalaemia in acute kidney injury in a heart failure patient with patiromer

Abstract

Aims: One prevalent comorbidity of chronic heart failure (CHF) is chronic kidney disease(CKD). Hyperkalemia is associated with both CHF and CKD, which often leads to withdrawal of heart failure medications in clinical praxis.

Methods and results: A patient is presented who suffered from acute kidney injury with pre-existing CKD as heart failure comorbidity and a history of hyperkalemia.

Conclusions: This case shows that potassium levels remained stable in acute kidney injury under ongoing heart failure medications, including an MRA, with the use of the potassium binder patiromer.

Keywords: Chronic Heart Failure; Chronic Kidney Failure; Heart Failure Therapy; Hyperkalemia.

Figure 1

A 69‐year old female patient presented with acute kidney failure with increased serum creatinine and serum urea and decreased serum creatinine–eGFR. Under ongoing heart failure medication and patiromer, serum potassium values could be kept stable. At acute hospitalization, serum creatinine (A) was at 3.2 mg/dL, serum creatinine–eGFR (B) at 14 mL/min/1.73 m², elevated serum urea (C) at 237 mg/dL, and serum sodium at 146 mmol/L (E). Under fluid therapy in the next 3 days, these values improved and reached output value. Potassium value (D) could be kept stable at output value throughout the acute kidney failure accompanied with stable blood pressure values during acute hospitalization (F). At Day 5, even up‐titration of spironolactone was possible. Big blue circles indicate value at index event when patiromer was started; small blue circles, average value under patiromer before acute hospitalization; green circles, values before taking of patiromer; yellow circles, value after 3 months' control. DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; SBP, systolic blood pressure.