HYPERKALAEMIA affected 28% of patients with heart failure in a Malaysian study, with chronic kidney disease emerging as a significant associated risk factor, while prescriptions for commonly used heart failure medications showed no significant association with elevated potassium levels.
The findings highlighted the importance of identifying patients at increased risk of hyperkalaemia and monitoring serum potassium concentrations during heart failure management.
Researchers conducted a retrospective, cross-sectional study at Hospital UiTM Sungai Buloh, Malaysia, to investigate hyperkalaemia frequency, heart failure medication prescribing patterns, and associated risk factors.
The study included 320 patients with heart failure who attended the hospital’s heart failure clinic between January 2023 and June 2025.
Medical records were reviewed to obtain demographic information, comorbidities, prescribed pharmacotherapies, and serum potassium measurements assessed 6–8 weeks after treatment initiation.
Hyperkalaemia was defined as a serum potassium concentration exceeding 5.0 mmol/L.
Overall, hyperkalaemia was identified in 28.0% of patients, indicating that elevated potassium levels were common within the study population.
Researchers examined associations between hyperkalaemia and prescriptions for renin–angiotensin–aldosterone system inhibitors (RAASi) and mineralocorticoid receptor antagonists (MRA).
RAASi were prescribed to 86.9% of patients, while 75.3% received MRA therapy.
Despite these prescribing rates, neither medication category demonstrated a statistically significant association with hyperkalaemia in the study population.
However, underlying chronic kidney disease was significantly associated with hyperkalaemia (p=0.001).
A significant association was also observed among patients with both chronic kidney disease and Type 2 diabetes (p=0.003).
These findings suggested that underlying comorbidities, particularly impaired kidney function, were important considerations when assessing hyperkalaemia risk in patients receiving heart failure treatment.
The study highlighted the clinical relevance of hyperkalaemia among patients with heart failure, particularly those with concurrent chronic kidney disease.
Although renin–angiotensin–aldosterone system inhibitors and mineralocorticoid receptor antagonists were frequently prescribed, their use was not significantly associated with hyperkalaemia in this cohort.
However, the retrospective, cross-sectional design did not establish causal relationships or exclude potential medication-related risks.
The researchers concluded that close monitoring of serum potassium concentrations is warranted in patients at increased risk, particularly those with underlying chronic kidney disease.
These findings may help inform risk assessment and monitoring strategies in heart failure clinics, while providing additional evidence from a Malaysian clinical population.
Reference
Zulkifly HH et al. Assessing the incidence and associated factors of hyperkalemia among heart failure patients in Hospital UiTM Sungai Buloh. Int J Cardi. 2026
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