Got the result of my annual bloods on Monday and my potassium level has come back as 5.5. That’s high and I’m getting repeat on Friday to rule out a false positive.
I’ve been on Entresto (top dose) and Eplerenone (25mg) for nearly 3 years after a STEMI HA in 2019 and have remained largely asymptomatic, despite my EF being in the clinical HF range. I’m wary of cutting down on either but they both present a significant risk of hyperkaelemia. My diet is fairly low in potassium (or so My Fitness Pal tells me!) so suspect it’s the drugs.
Has anyone experienced high P with these drugs and been given an alternative that works well?
Seems like you anticipate another high Potassium result. This can be a medical emergency, so please do follow medical advice. At the very least your doctor may want to check you out to make sure there are not other problems.
Beyond that, with treatments, I think a fair question is to ask the doctor "What are the options?"
I have recently been looking into "pseudo-hyperkalemia", The problems in Potassium measurement include:
++ It is highly sensitive to the way the blood is taken, and to how quickly it gets to the lab etc. There are other measurement problems.
++ It is sensitive to nervousness, cold, and exercise and some medicines
++ It can lead to abnormal heart behaviour, which kills, and other problems eg kidney.
You are measuring serum Potassium, which is 2-3% of the cellular Potassium, and cells easily release Potassium into the serum.
Then there is the elephant in the room: basic probability. I think the probability of a false positive is as high as 50% ie 1/2. The probability of two false positives is therefore 1/4 and three in a row as 1/8. Doctors usually take three - in - a - row as definitive. Yet long runs of positives are quite common.
Then there is the question, rarely mentioned: is the high Potassium a cause of problems or associated with problems?
There are well documented cases of people living a long time with high Potassium levels. So, as ever, acute (sudden change) is more suspicious than chronic.
But, you do not know if the high Potassium level represents chance, or means real life threatening danger, and that is for your doctors to advise. I hope this helps.
Many thanks ILowe - fascinating insights there. One thing I did not mention is that I had the test done straight after a gym session! While I always try and stay well hydrated at the gym, and this was no exception, I do wonder if dehydration may be a factor. Should get the results early next week, so fingers crossed.
My husband has had high potassium issues for years. A level of 5.5 isn't very high, it's just out of range, so I wouldn't be too concerned. Often the level is affected by the way the blood has been taken, transportation of blood to the lab, how long the blood was standing before being tested etc which is why you always have a follow up blood test. If it is a true reading then getting the level down isn't too difficult. My husband's level was 5.9, his GP said if it had been any higher she would have referred him to hospital. He had to stop taking his candesartan for a month & drink lots of water to flush it through. His potassium was tested every week & after the month his level was low enough for him to go back on his candesartan. ( Please dont stop meds or drink more fluids unless your medical team tell you too. I don't believe it becomes a medical emergency until your level is 7 or over, that's what we were told some years ago by the hospital. When you have your bloods taken do not pump your hand into a fist, this is a really common cause of false high potassium levels. Often you're told to make a fist so it's easier to get the needle into your veins, but a lot of phlebotomist are not aware that it affects your potassium readings. Good luck for Friday
Thanks Lezzers - your context and advice is much appreciated. I feel fine but am not taking this lightly as I have always been a little uneasy about taking two drugs with a relatively significant risk of this effect. My eGFR was normal, so assuming it’s not indicative of a secondary condition.
I get your concerns, unfortunately a number of heart meds can effect your kidneys. I once asked my husband's nurse about this sone years ago and was told the heart must take priority & that they can 'do things' for the kidneys. My husband's eGFR has slipped in & out of normal range for years, so far it's never been an issue. Entresto is a very good med for your heart as it's been proven to reduce hospitalisation & mortality. An alternative could be candesartan or ramipril but both of these can increase potassium. First line treatment for HF includes a diuretic, spirolactone is the preferred one as this helps prevent fluid retention but it's notorious for increasing potassium, I believe if someone can't tolerate spirolactone (potassium etc) then Eplerenone is usually prescribed. I would wait until you've had your 2nd results & then discuss with your medical team. But do be remember that the fact you're asymptomatic would be down to the medication you're taking. I personally wouldn't want to change medication that's working, purely because it 'may' affect your kidneys. Would be interested in the results of Fridays blood test if you wouldn't mind sharing them
Hi Lezzers - as requested, my potassium came back as 4.7 so probably a false positive. I’m still a little bothered by the eGFR though, so will discuss with GP next Mon. I was actually due to have a meds review last year - it was booked over the phone so I was given the usual 4 hour window to pick up after 3 rings. I wasn’t fast enough in picking up during a work meeting so that was that!
Good to hear it's a more normal level. The first time my husbands potassium went too high was back in 2008, out of the blue he got a phone call from the GP admitting his potassium had been rising & no one had noticed so he was being referred to the hospital as an urgent case. Once we got there the Dr said they wouldn't be concerned unless the level was 7 or 8! I might be wrong (I usually am!) But I think GP's have recently been reminded that medication reviews should be carried out yearly (obviously these things got missed due to the not to be mentioned C word!) I would definitely discuss with your GP. I think I mentioned that my husband's eGFR slips in & out of mild kidney disease, he's recently had to increase his diuretic due to fluid retention so he'll having another test at the end of the month. Ps: I've just seen your comment about your eGFR being 90 & it being the lower end of normal. Have you taken into consideration your age (hope that's not rude of me, I don't actually know how old you are!) as what I'd considered normal changes with age. My husband is 67, his eGFR is currently low 60's and that's considered normal for him. Definitely something to discuss with your GP, good luck 🤞
Update - just had my blood test done and took the opportunity to ask for my eGFR after taking the “everything else (bar potassium) is fine” comment at face value. Turns out it’s at 90, which is the absolute lowest end of normal.
Even if the potassium result turns out to be a false positive, I am now thinking very hard about the Eplerenone and Entresto combo, especially as I was put on them when I had zero symptoms - it was all guided by the EF number. I’m also wondering if Lansoprazole may be a culprit.
Feels like at least lowering the doses across the board may be the way forward- looking forward to my convo with the GP in a week’s time.
I also take Entresto, Eplerenone, Lansoprazole, Dapagliflozin, Aspirin, Clopidogrel oh and Pravastatin for good measure. LOL wonder should I press for a Blood Test LOL.
Hi Prada. I also take most of them for good measure. I havent ever had water retention or most of the usual symptoms to be fair.. Now have a ef rate of 42%. I do wonder why they put us on high dose of entresto and water tablets... What would happen if symptoms come along bad... They cant increase any more, they have used up all their ammo so to speak.
Hi Prada. My ef has held steady at 38% for the last 2 years, based on annual echo. My MI was in March 2019, on discharge ef was 35%, then bounced around between 38-45% over the next 9 months. As these were all echo results I asked for something more definitive and went for CMRI. Careful what you wish for - that came back as 34% and off I went for an ICD! No symptoms to speak of and I pushed for Entresto (Sep 2020) hoping for a magical bump in my EF. That hasn’t materialised, but all echoes since have shown 35-40% and cardiologist said “let’s call it 38”. I do wonder if I’m a little over-medicated (completed stage 5 on the Bruce protocol ETT last year wearing a surgical mask) but no dapa yet and who knows how I’d feel if current doses were lowered. My main issues are twinge-related anxiety and some recurrent heaviness/pressure in the sternum if I don’t take Lansoprazole (15mg) but I’m trying to space out that particular medication due to potential issues with potassium. I’m 50 btw.
Hello I see what you mean about using everything up before you get sever symptons. My Heart Failure Nurse told me " You are at the end of the Road for Medication maybe we could try a CRT as you would be to old for a Transplant lol
Breathing has been better since Intervention Cardiologist opened my already bypassed LAD approx 25% of my Heart Muscle is Dead i.e. nothing to be done with it. So just soldier on my ef was 38% on last MRI that is down a little from 44/42 % HF Nurse in March will be interesting conversation.
Only problem at the moment is Varicose Veins have appeared on my leg where the vein for the bypass was taken, oh and my ankle is quite sore especially during the night maybe holding a little fluid !!! we will see.
Diet plays a significant part imo. I am stopping nuts, bananas, and cutting back on other foods I can easily do without, like potatoes. Have been eating low sodium potato chips, not very often, but they are loaded with potassium.
Interesting article to Google: Entresto in HF Tied to Less Kidney Decline
No - the issue is a mechanical deficit due to tissue damage from HA, and nothing short of a breakthrough in regenerative medicine will fix that. Still, very few symptoms to speak of so I think the meds are doing a good job of managing that.
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