Abstract 12831: Serum Potassium Levels and Mortality in Heart Failure Patients. A Meta-Analysis

Abstract

Introduction: Serum potassium disturbances are frequently observed in patients with heart failure (HF) and can be attributed, to some extent, to comorbidities and the use of diuretics, mineralocorticoid receptor antagonists, and renin-angiotensin-aldosterone system antagonists. Previous studies on the prognostic implications of potassium homeostasis impairment have yielded heterogeneous findings. This meta-analysis aims to evaluate the association between serum potassium levels and mortality in HF patients. Methods: A comprehensive search was conducted across various electronic databases, including PubMed, Embase, and the Cochrane Library, to identify relevant studies. The primary outcomes assessed were all-cause mortality and cardiovascular mortality. The DerSimonian-Laird random-effects model was used to pool the outcomes, and the results were presented as hazard ratios (OR) with 95% confidence intervals (CI). Meta-regression was performed to identify potential sources of heterogeneity. Results: A total of twelve studies involving 45,678 HF patients were included in the analysis. Among them, 3,298 patients were hypokalemic, 38,328 were normokalemic, and 4,052 were hyperkalemic. The follow-up period was 1.5 (1- 2.8) years. The meta-analysis of adjusted effect sizes revealed that both hypokalemia (HR 1.68, 95% CI: 1.38-2.05, p < 0.001) and hyperkalemia (HR 1.36, 95% CI: 1.17-1.57, p < 0.001) were significantly associated with increased all-cause mortality. When compared to normokalemic patients, those with hypokalemia had a significantly higher risk of cardiovascular mortality (HR 1.77, 95% CI: 1.02-3.07, p = 0.01), whereas no significant association was found for hyperkalemia (HR 1.13, 95% CI: 0.98-1.31, p = 0.10). Univariate meta-regression analysis did not identify any significant moderators of effect size. Conclusions: This study reveals a U-shaped relationship between serum potassium levels and all-cause mortality in patients with heart failure. Hypokalemia is additionally associated with cardiovascular mortality.