Dyskalemia is common among patients with heart failure (HF) and it is associated with increased mortality, according to a new study that identified independent predictors of hyper- and hypokalemia in this patient population.

The study included 5848 patients enrolled in the Swedish HF registry from 2006 to 2011 in Stockholm, Sweden, examined the 1-year incidence and predictors of dyskalemia and its outcomes. Of these patients, 24.4% experienced hyperkalemia (potassium level above 5.0 mmol/L) at least once, 10.2% had moderate to severe hyperkalemia (potassium level greater than 5.5 mmol/L), and 3.7% had severe hypokalemia (potassium level below 3.0 mmol/L).

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The risk of moderate or severe hyperkalemia was highest among patients with preserved ejection fraction (EF) and HF with mid-range EF, whereas the risk of hypokalemia was highest among those with preserved EF, Gianluigi Savarese, MD, PhD, of the Karolinska Institutet in Stockholm, Sweden, and colleagues reported in JACC: Heart Failure.

Independent predictors of both hyper- and hypokalemia were sex, high and low baseline potassium level, low estimated glomerular filtration rate, chronic obstructive pulmonary disease, New York Heart Association functional class, and low hemoglobin, according to the investigators.

Dyskalemia was associated with increased mortality. Hypokalemia was associated with an increased risk of hospitalizations due to cardiovascular disease (HF-related excluded). The study found no association between dyskalemia and HF hospitalization risk, regardless of EF, the investigators reported.


Savarese G, Xu H, Trevisan M, et al. Incidence, predictors, and outcome associations of dyskalemia in heart failure with preserved, mid-range, and reduced ejection fraction. JACC Heart Fail. 2018; published online ahead of print.