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Abstract: FR-OR19

Dapagliflozin Reduces the Risk of Hyperkalaemia in Patients with Heart Failure and Reduced Ejection Fraction: A Secondary Analysis from DAPA-HF

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Kristensen, Søren Lund, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
  • Docherty, Kieran F., BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
  • Jhund, Pardeep, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
  • Bengtsson, Olof, AstraZeneca, Gothenburg, Sweden
  • Inzucchi, Silvio E., Yale University, New Haven, Connecticut, United States
  • Kosiborod, Mikhail, St Lukes Mid America Heart Institute, Kansas City, Kansas, United States
  • Langkilde, Anna Maria, AstraZeneca, Gothenburg, Sweden
  • Martinez, Felipe, National University of Cordoba, Cordoba, Argentina
  • Ponikowski, Piotr, Wroclaw Medical University, Wroclaw, Poland
  • Sabatine, Marc S., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Sjostrand, Mikaela, AstraZeneca, Gothenburg, Sweden
  • Solomon, Scott D., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • McMurray, John, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
Background

Hyperkalaemia often limits the use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure and reduced ejection fraction (HFrEF), denying these patients a life-saving therapy.

Methods

The risk of developing mild hyperkalaemia (potassium > 5.5 mmol/L) and moderate/severe hyperkalaemia (>6.0 mmol/L) was examined in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) according to background MRA use, and randomized treatment assignment, by use of Cox regression analyses.

Results

Overall, 3370 (70.1%) patients in DAPA-HF were treated with an MRA. Mild hyperkalaemia and moderate/severe hyperkalaemia occurred in 182 (11.1%) and 23 (1.4%) patients treated with dapagliflozin as compared to 204 (12.6%) and 40 (2.4%) of patients given placebo (Table and Figure). This yielded a hazard ratio (HR) of 0.86 (0.70-1.05) for mild hyperkalaemia and 0.50 (0.29, 0.85) for moderate/severe hyperkalaemia, comparing dapagliflozin to placebo.

Conclusion

Patients with HFrEF and taking an MRA who were randomized to dapagliflozin had half the incidence of moderate/severe hyperkalaemia, compared with those randomized to placebo.

Incident hyperkalaemia in DAPA-HF

Cumulative incidence of hyperkalaemia in patients taking MRA at baseline

Funding

  • Commercial Support –