Background Renin-angiotensin-aldosterone system inhibitors (RAASi) improve prognosis in patients with heart failure with reduced ejection fraction (HFrEF), but suboptimal dosing or discontinuation of these medications often occurs due to RAASi-associated hyperkalaemia. We established a nephrology-led hyperkalaemia clinic to oversee prescribing of patiromer, an oral potassium-binder, to facilitate RAASi optimisation. Methods The clinic was established in July 2019 at a nephrology tertiary centre in the United Kingdom. Patients with HFrEF who were unable to increase RAASi dosage due to hyperkalaemia were referred to the clinic, where all patients commenced patiromer 8.4g daily. RAASi adjustments were deferred to the referring teams. Study outcomes included the percentage of patients who achieved a RAASi dose increase and the proportion of patients with normokalaemia at follow-up. Outcomes were evaluated until 1st May 2021. Results A total of 34 patients were reviewed in the clinic between July 2019 and December 2020. Mean age was 71.6 years (±10.6 years), 56% had diabetes and 71% had chronic kidney disease stages 3a-5; mean estimated glomerular filtration rate was 56ml/min/1.73m2 (±21ml/min/1.73m2). During follow-up, 12 patients discontinued patiromer (6 of whom did so due to gastrointestinal side effects) and were discharged; two patients died from non-hyperkalaemia related illness, and one switched to an alternative potassium-binder. Over a mean follow-up of 13.4 months (±5.8 months), 17 of the 20 patients (85%) who continued with a potassium-binder achieved a RAASi dose increase, with 4 patients (21%) receiving maximal dosages. This was attained by achieving normokalaemia during follow-up. No patients required magnesium supplementation. Of the 19 patients on patiromer, 12 continued this therapy for more than 12 months and 4 received it safely for 20 months. Discussion/Conclusion Patiromer prescribing in a nephrology-led hyperkalaemia clinic facilitated RAASi up-titration in patients with HFrEF by controlling potassium levels.


中文翻译：

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定制高钾血症诊所的经验，以促进射血分数降低的心力衰竭患者肾素-血管紧张素-醛固酮系统抑制剂的处方

背景 肾素-血管紧张素-醛固酮系统抑制剂 (RAASi) 可改善射血分数降低的心力衰竭 (HFrEF) 患者的预后，但由于 RAASi 相关的高钾血症，这些药物的剂量通常不理想或停药。我们建立了一个以肾脏科为主导的高钾血症诊所，以监督 patiromer（一种口服钾结合剂）的处方，以促进 RAASi 优化。方法 该诊所于 2019 年 7 月在英国一家肾脏病学三级中心成立。由于高钾血症而无法增加 RAASi 剂量的 HFrEF 患者被转诊至诊所，所有患者开始每天服用 patiromer 8.4g。RAASi 调整被推迟到推荐团队。研究结果包括达到 RAASi 剂量增加的患者百分比和随访时血钾正常的患者比例。结果评估截止到 2021 年 5 月 1 日。结果 2019 年 7 月至 2020 年 12 月期间，共有 34 名患者在门诊接受检查。平均年龄为 71.6 岁（±10.6 岁），56% 患有糖尿病，71% 患有慢性肾病 3a 期-5; 平均估计肾小球滤过率为 56ml/min/1.73m2 (±21ml/min/1.73m2)。随访期间，12 名患者停用 patiromer（其中 6 名患者因胃肠道副作用停用）并出院；两名患者死于与高钾血症无关的疾病，一名患者改用另一种钾结合剂。平均随访 13.4 个月（±5.8 个月），继续使用钾结合剂的 20 名患者中有 17 名 (85%) 实现了 RAASi 剂量增加，其中 4 名患者 (21%) 接受了最大剂量。这是通过在随访期间实现正常血钾来实现的。没有患者需要补充镁。在接受 patiromer 治疗的 19 名患者中，有 12 名患者继续这种治疗超过 12 个月，4 名患者安全接受了 20 个月。讨论/结论 Patiromer 在肾脏科主导的高钾血症诊所开出处方，通过控制钾水平促进 HFrEF 患者的 RAASi 上调。