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Association of abnormal serum potassium levels with arrhythmias and cardiovascular mortality: a systematic review and meta-analysis of observational studies

Purpose: To provide the first systematic review and meta-analysis of observational studies on the association of abnormal serum potassium and cardiovascular outcomes.Methods: Medline and ISI Web of Knowledge were systematically searched from inception until November 24, 2017. Data synthesis of relev...

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Main Authors: Hoppe, Liesa Katharina (Author) , Laetsch, Dana Clarissa (Author) , Brenner, Hermann (Author) , Schöttker, Ben (Author)
Format: Article (Journal)
Language:English
Published: 2018
In: Cardiovascular drugs and therapy
Year: 2018, Volume: 32, Issue: 2, Pages: 197-212
ISSN:1573-7241
DOI:10.1007/s10557-018-6783-0
Online Access:Verlag, Volltext: http://dx.doi.org/10.1007/s10557-018-6783-0
Verlag, Volltext: https://link.springer.com/article/10.1007/s10557-018-6783-0
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Author Notes:Liesa K. Hoppe, Dana C. Muhlack, Wolfgang Koenig, Prudence R. Carr, Hermann Brenner, Ben Schöttker

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520 |a Purpose: To provide the first systematic review and meta-analysis of observational studies on the association of abnormal serum potassium and cardiovascular outcomes.Methods: Medline and ISI Web of Knowledge were systematically searched from inception until November 24, 2017. Data synthesis of relevant studies was performed using random effects model meta-analyses.Results: Meta-analyses included 310,825 participants from 24 studies. In the older general population, low serum potassium was associated with a 1.6-fold increased risk of supraventricular arrhythmias (risk ratio [95% confidence interval] 1.62 [1.02-2.55]). Contrarily, high serum potassium was associated with increased cardiovascular mortality (CVM) (1.38 [1.14-1.66]). In patients with acute myocardial infarction, the risk of ventricular arrhythmias was increased for high serum potassium (2.33 [1.60-3.38]). A U-shaped association was observed with a composite cardiovascular outcome in hypertensive patients (2.6-fold increased risk with hypokalemia and 1.7-fold increased risk with hyperkalemia), with CVM in dialysis patients (1.1-fold increased risk with hypokalemia and 1.4-fold increased risk with hyperkalemia) and with CVM in heart failure patients (albeit not statistically significant). Further, only hyperkalemia was associated with an increased risk of a composite cardiovascular outcome in both dialysis (1.12 [1.03-1.23]) and chronic kidney disease (1.34 [1.06-1.71]) patients.Conclusions: Controlled clinical trials are needed to determine which populations may profit from more frequent potassium-monitoring and subsequent interventions, e.g., change or withdrawal of potassium-influencing drugs, in order to restore normal values and prevent cardiovascular outcomes. 
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