Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709–17.

Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11–21.

Article  CAS  PubMed  Google Scholar 

Rossignol P, Duarte K, Girerd N, et al. Cardiovascular risk associated with serum potassium in the context of mineralocorticoid receptor antagonist use in patients with heart failure and left ventricular dysfunction. Eur J Heart Fail. 2020;22(8):1402–11.

Article  CAS  PubMed  Google Scholar 

Patel RB, Fonarow GC, Greene SJ, et al. Kidney function and outcomes in patients hospitalized with heart failure. J Am Coll Cardiol. 2021;78(4):330–43.

Article  PubMed  PubMed Central  Google Scholar 

Raebel MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Cardiovasc Ther. 2012;30(3):e156–66.

Article  CAS  PubMed  Google Scholar 

Hsu TW, Liu JS, Hung SC, et al. Renoprotective effect of renin-angiotensin-aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia. JAMA Intern Med. 2014;174(3):347–54.

Article  PubMed  Google Scholar 

Kohsaka S, Okami S, Morita N, Yajima T. Risk-benefit balance of renin-angiotensin-aldosterone inhibitor cessation in heart failure patients with hyperkalemia. J Clin Med. 2022;11(19):5828.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4S):S117–S314.

McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726.

Article  CAS  PubMed  Google Scholar 

Kanda E, Rastogi A, Murohara T, et al. Clinical impact of suboptimal RAASi therapy following an episode of hyperkalemia. BMC Nephrol. 2023;24(1):18.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Rosano GMC, Tamargo J, Kjeldsen KP, et al. Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother. 2018;4(3):180–8.

Article  PubMed  Google Scholar 

Epstein M, Reaven NL, Funk SE, McGaughey KJ, Oestreicher N, Knispel J. Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors. Am J Manag Care. 2015;21(11 Suppl):S212–20.

PubMed  Google Scholar 

Linde C, Bakhai A, Furuland H, et al. Real-world associations of renin-angiotensin-aldosterone system inhibitor dose, hyperkalemia, and adverse clinical outcomes in a cohort of patients with new-onset chronic kidney disease or heart failure in the United Kingdom. J Am Heart Assoc. 2019;8(22):e012655.

Article  PubMed  PubMed Central  Google Scholar 

Girerd N, Von Hunolstein JJ, Pellicori P, et al. Therapeutic inertia in the pharmacological management of heart failure with reduced ejection fraction. ESC Heart Fail. 2022;9(4):2063–9.

Article  PubMed  PubMed Central  Google Scholar 

Garred CH, Zahir D, Butt JH, et al. Adherence and discontinuation of optimal heart failure therapies according to age: a Danish nationwide study. J Am Heart Assoc. 2022;11(19):e026187.

Article  PubMed  PubMed Central  Google Scholar 

Smith KV, Dunning JR, Fischer CM, et al. Evaluation of the usage and dosing of guideline-directed medical therapy for heart failure with reduced ejection fraction patients in clinical practice. J Pharm Pract. 2022;35(5):747–51.

Article  PubMed  Google Scholar 

Thomsen RW, Nicolaisen SK, Hasvold P, et al. Elevated potassium levels in patients with congestive heart failure: occurrence, risk factors, and clinical outcomes: a Danish population-based cohort study. J Am Heart Assoc. 2018;7(11):e008912.

Svensson MK, Murohara T, Lesén E, et al. Hyperkalaemia-related reduction of RAASi treatment associates with more subsequent inpatient care. Nephrol Dial Transplant. 2024:gfae016.

Burton JO, Coats AJS, Kovesdy CP, et al. An international Delphi consensus regarding best practice recommendations for hyperkalaemia across the cardiorenal spectrum. Eur J Heart Fail. 2022;24(9):1467–77.

Article  PubMed  Google Scholar 

Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med. 2004;351(6):585–92.

Article  CAS  PubMed  Google Scholar 

Trevisan M, Fu EL, Xu Y, et al. Stopping mineralocorticoid receptor antagonists after hyperkalaemia: trial emulation in data from routine care. Eur J Heart Fail. 2021;23(10):1698–707.

Article  CAS  PubMed  Google Scholar 

Butler J, Anker SD, Lund LH, et al. Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial. Eur Heart J. 2022;43(41):4362–73.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Kosiborod M, Rasmussen HS, Lavin P, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA. 2014;312(21):2223–33.

Article  PubMed  Google Scholar 

Spinowitz BS, Fishbane S, Pergola PE, et al. Sodium zirconium cyclosilicate among individuals with hyperkalemia: a 12-month phase 3 study. Clin J Am Soc Nephrol. 2019;14:798–809.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Esposito I, Dell’aversana S, Basile C, et al. 488 Novel potassium binders improves raasi therapy optimization in heart failure: a systematic review and meta-analysis. Eur Heart J Suppl. 2022;24(Suppl_K):suac121.427.

Williams R, James A, Ashton M, Vaughan S, Wong A. Use of sodium zirconium cyclosilicate for up-titration of renin-angiotensin-aldosterone system inhibitor therapy in patients with heart failure: a case series. Eur Heart J Case Rep. 2021;5(8):ytab281.

Imamura T, Oshima A, Narang N, Kinugawa K. Clinical implications of sodium zirconium cyclosilicate therapy in patients with systolic heart failure and hyperkalemia. J Clin Med. 2021;10(23):5523.

Morales E, Cravedi P, Manrique J. Management of chronic hyperkalemia in patients with chronic kidney disease: an old problem with news options. Front Med (Lausanne). 2021;8:653634.

Article  PubMed  Google Scholar 

Dunn JD, Benton WW, Orozco-Torrentera E, Adamson RT. The burden of hyperkalemia in patients with cardiovascular and renal disease. Am J Manag Care. 2015;21(15 Suppl):s307–15.

PubMed  Google Scholar 

Kovesdy CP. Updates in hyperkalemia: outcomes and therapeutic strategies. Rev Endocr Metab Disord. 2017;18(1):41–7.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Rastogi A, Pollack CV Jr, Sánchez Lázaro IJ, et al. Maintained renin–angiotensin–aldosterone system inhibitor therapy with sodium zirconium cyclosilicate following a hyperkalaemia episode: a multi-country cohort study. Clin Kidney J. 2024;17(5):sfae083.

Kosiborod MN, Cherney D, Connelly K, et al. Sodium zirconium cyclosilicate in patients with HFrEF and hyperkalemia: REALIZE-K rationale, design, and baseline characteristics. JACC Heart Fail. 2024;12(10):1707–1716.

Trevisan M, de Deco P, Xu H, et al. Incidence, predictors and clinical management of hyperkalaemia in new users of mineralocorticoid receptor antagonists. Eur J Heart Fail. 2018;20(8):1217–26.

Article  CAS  PubMed  Google Scholar 

Neuen BL, Oshima M, Agarwal R, et al. Sodium-glucose cotransporter 2 inhibitors and risk of hyperkalemia in people with type 2 diabetes: a meta-analysis of individual participant data from randomized. Controlled Trials Circulation. 2022;145(19):1460–70.

CAS  PubMed  Google Scholar 

Kristensen SL, Docherty KF, Jhund PS, et al. Dapagliflozin reduces the risk of hyperkalaemia in patients with heart failure and reduced ejection fraction: a secondary analysis DAPA-HF. Eur Heart J. 2020;41(Suppl 2):ehaa946.0939.

Roger SD, Spinowitz BS, Lerma EV, et al. Efficacy and safety of sodium zirconium cyclosilicate for treatment of hyperkalemia: an 11-month open-label extension of HARMONIZE. Am J Nephrol. 2019;50(6):473–80.

Article  CAS  PubMed  Google Scholar 

Mullens W, Damman K, Dhont S, et al. Dietary sodium and fluid intake in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC. Eur J Heart Fail. 2024;26(4):730–41.