Heart Failure Fact or Fiction: Hyperkalemia and SGLT2i

A 68-year-old man with a medical history of heart failure with reduced ejection fraction (HFrEF; 30%), type 2 diabetes mellitus, and chronic kidney disease presents to the office for evaluation and optimization of his medication regimen. He reports shortness of breath when walking up two flights of stairs.

His current medications include sacubitril/valsartan 49/51 mg BID, metoprolol succinate 100 mg daily, and spironolactone 25 mg daily.

His laboratory studies reveal creatinine level 1.3 mg/dL (estimated glomerular filtration rate 48 mL/min/1.73 m2) and potassium level 4.8 mEq/L.

A sodium-glucose cotransporter-2 inhibitor (SGLT2i) should not be started at this time due to the risk of worsening hyperkalemia in the setting of chronic kidney disease.

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