Empiric potassium supplementation of furosemide improves heart failure survival

By David Douglas

NEW YORK (Reuters Health) - Supplements to combat urinary potassium loss in heart failure patients on furosemide appear to improve survival, according to an observational study by Philadelphia-based researchers.

"Given that a randomized trial is unlikely, this study may provide the long-awaited evidence to support empiric potassium use in furosemide users," Dr. Charles E. Leonard told Reuters Health by email.

In a July 16th online paper in PLOS ONE, Dr. Leonard and colleagues at the University of Pennsylvania note that in 2000, the National Council on Potassium in Clinical Practice recommended that potassium supplementation be routinely considered in patients receiving a non potassium-sparing diuretic even if normokalemic. But despite this and similar recommendations, no studies have examined the efficacy of empiric potassium supplementation.

For the new study, the researchers analyzed data from 1999 to 2007 covering five states and about 38% of the US Medicaid population. Empiric potassium supplementation was defined as a potassium prescription on the day of or the day after the initial loop diuretic prescription.

More than 654,000 people met eligibility criteria and 96% initiated therapy with furosemide. Of these, 27% received empiric potassium supplementation.

For all-cause death, using one-to-one propensity score matching, the hazard ratio for empiric potassium supplementation was 0.93.

The relative mortality reduction in those whose initial furosemide dose was less than 40 mg/day was 7% and at the threshold for statistical significance, say the investigators. But it was 16% and statistically significant in those whose initial furosemide dose was 40 mg/day or more.

In a statement, co-author Dr. Sean Hennessy noted that "potassium supplementation for patients receiving loop diuretic therapy may be a relatively inexpensive way to save lives. In today's climate of seeking cost-effective measures to keep patients healthy, this is a therapy that certainly merits additional consideration."

However, Dr. Leonard added, ""While the survival benefit of this practice would be substantial, replication of our findings may be warranted before informing clinical practice guideline change."

SOURCE: http://bit.ly/1rimCYK

PLOS ONE 2014.

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