Potassium Profile in Heart Failure Patients Before and After Hospitalization at Prof. Dr. I.G.N.G. Ngoerah Hospital
Background: Hypokalemia in patients with heart failure is increasing, with an increasing incidence of 6.8% in Asia and 19.7% in Indonesia; globally, 63 million people suffer from heart failure. Hypokalemia is defined as a serum potassium level below 3.5 mEq/L [mmol/L], which can lead to decreased heart function, muscle weakness, arrhythmias and cardiac arrest. The use of diuretic drugs such as furosemide in heart failure patients may be a risk factor for hypokalemia. Objective: This study aims to determine the difference in potassium levels before and after furosemide administration as well as the possibility of hypokalemia due to furosemide administration in inpatients diagnosed with heart failure at Prof. Dr. I.G.N.G. Ngoerah Hospital. Methods: This is a cross-sectional observational study with retrospective medical record collection. The minimum sample size was calculated using Lemeshow's Formula of One Proportion Estimation Method with Absolute Precision Proportion, data normality test with Kolmogorov-Smirnov (p>0.05) and parametric test with paired t-test (p<0.05). This study included 101 patients that met the inclusion criteria with 11 patients having more than one inpatient visit, so a total 114 'patients' medical records were obtained. Results: Potassium levels before and after hospitalization showed a significant difference (p<0.05). A total of 84 'patients' data showed a decrease in potassium levels, with 49 of them showing a reduction in >15% and 35 showing a decrease of ≤15%. Conclusion: Prevalence of hypokalemia in patients with a diagnosis of heart failure and furosemide therapy at Prof. Dr. I.G.N.G. Ngoerah Hospital during January 2022-December 2023 after hospitalization was 29%.
Aimbudlop, K., & Saengpanit, D. (2023) Factors Associated with Hypokalemia after Furosemide Treatment in Hospitalized Patients with Acute Decompensated Heart Failure. Journal of the Nephrology Society of Thailand, 30(1): 57-68
Bozkurt, B., Ahman, T., Alexander, K., Yancy, C., & Ziaeian, B. (2025). HF STATS 2024: Heart Failure Epidemiology and Outcomes Statistics an Updated 2024 Report from the Heart Failure Society of America. Journal of Cardiac Failure, 31(1): 66-116
Chang, A. R., Sang, Y., Leddy, J., Yahya, T., Kirchner, H. L., Inker, L. A., Matsushita, K., Ballew, S. H., Coresh, J., & Grams, M. E. (2016). Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System. Hypertension, 67(6): 1181-1188
DiPiro, J. S., Yee, G. C., Posey, L. M., Haines, S. T., Nolin, T. D., & Ellingrod, V. (2021). Pharmacotherapy Handbook. 11th edn. USA: McGraw Hill.
Donsu, R. A., Rampengan, S. H., & Polii, N. (2020). Karakteristik Pasien Gagal Jantung Akut di RSUP Prof Dr. R. D. Kandou Periode Januari-Desember 2018. Medical Scope Journal, 1(2):30–37.
Ferreira, J. P., Butler, J., Rossignol, P., Pitt, B., Anker, S. D., Kosiborod, M., Lund, L. H., Bakris, G. L., Weir, M. R., & Zannad, F. (2020). Abnormalities of Potassium In Heart Failure: Jacc State-Of-The-Art Review. Journal of The American College Of Cardiology, 75(22):2836-2850.
Felker, G.M., Ellison, D.H., Mullens, W., Cox, Z. L., & Testani, J. M. (2020). Diuretic Therapy for Patients with Heart Failure: JACC State-Of-The-Art Review. Journal of the American College of Cardiology, 75(10):1178-1195.
Goia-Nishide, K., Coregliano-Ring, L., & Rangel, É.B. (2022). Hyperkalemia in Diabetes Mellitus Setting. Diseases, 10(20): 1-17
Gottdiener, J. S., Buzkova, P., Kahn, P. A, DeFilippi, C., Shah, S., Barasch, E., Kizer, J. R., Psaty, B., & Gardin, J. M. (2022). Relation of Cigarette Smoking and Heart Failure in Adults ≥ 65 Years of Age (From The Cardiovascular Health Study). The American Journal Of Cardiology, 168: 90-98.
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S… Yancy, C.W. (2022). AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18): 895–1032.
Jun, H.R., Kim, H., Lee, S.H., Cho, J. H., Lee, H., Yim, H. W., Yoon, K. H., & Kim, H. S. (2021). Onset of Hyperkalemia Following the Administration of Angiotensin‐Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker. Cardiovascular Therapeutics, 1: 5935149.
Kellum, J. A., Romagnani, P., Ashuntantang, G., Ronco, C., Zarbock, A., & Anders, H. J. (2021). Acute Kidney Injury. Nature reviews. Disease Primers, 7(1): 52.
Oktaviono, Y. H., & Kusumawardhani, N. (2020). Hyperkalemia Associated with Angiotensin Converting Enzyme Inhibitor or Angiotensin Receptor Blockers In Chronic Kidney Disease. Acta Medica Indonesiana, 52(1):74-79.
Patibandla, S., Heaton, J., & Kyaw, H. (2024). Spironolactone. https://www.ncbi.nlm.nih.gov/books/NBK554421
PERKI (Perhimpunan Dokter Spesialis Kardiovaskular Indonesia). (2020). Pedoman Tatalaksana Gagal Jantung. 2nd edn. Jakarta Barat: Perhimpunan Dokter Spesialis Kardiovaskular Indonesia.
Powell-Wiley, T.M., Poirier, P., Burke, Després, J. P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., & St-Onge, M. P. on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council (2021). Obesity and Cardiovascular Disease: A Scientific Statement From The American Heart Association. Circulation, 143(21): 984-1010.
Rawal, K.B., Chhetri, D.R., Giri, A., Girish, H.N., Luhar, M.B., Anusha, S., Ashvil, A., & Lalrinsiama, R. (2021). Metoprolol-Induced Hyperkalemia–A Case Report. Indian Journal of Medical Sciences, 73(2):253-255.
Ring, L.C., Nishide, K.G., & Rangel, E.B. (2022). Hypokalemia in Diabetes Mellitus Setting. Medicina, 58(431): 1-18
Riskesdas. (2018). Hasil Utama Riset Kesehatan Dasar (RISKESDAS). Jakarta: Kementerian Kesehatan Republik Indonesia.
Riyadina, W. (2019). Hipertensi pada Wanita Menopause. Jakarta: LIPI Press.
Rizos, C.V., Milionis, H.J., & Elisaf, M.S. (2017). Severe Hyperkalemia Following Blood Transfusions: Is There a Link? World Journal of Nephrology, 6(1): 53-56
Rosano, G.M.C., Seferovic, P., Savarese, G., Spoletini, I., Lopatin, Y., Gustafsson, F., Bayes-Genis, A., Jaarsma, T., Abdelhamid, M., Miqueo, A. G., Piepoli, M., Tocchetti, C. G., Ristić, A. D., Jankowska, E., Moura, B., Hill, L., Filippatos, G., Metra, M., Milicic, D…Coats, A. J. S. (2022). Impact Analysis of Heart Failure Across European Countries: an ESC-HFA Position Paper. ESC Heart Failure, 9: 2767–2778.
Rumaisyah, R., Fatmawati, I., Arini, F. A., & Octaria, Y. C. (2023). Association between Types of Obesity and Hypertension in Young Adults in Indonesia. Amerta Nutrition, 7.
Sarnowski, A., Gama, R.M., Dawson, A., Mason, H., & Banerjee, D., (2022). Hyperkalemia in Chronic Kidney Disease: Links, Risks and Management. International Journal of Nephrology and Renovascular Disease, 2(15): 215-228
Savarese, G., Becher, P.M., Lund, L.H., Seferovic, P., Rosano, G.M.C, & Coats, A.J. (2022). Global Burden of Heart Failure: A Comprehensive and Updated Review of Epidemiology. European Society of Cardiology, 118: 3272–3287.
Sun, K., Su, T., Li, M., & Xu, B. (2014). Serum potassium level is associated with metabolic syndrome: A population-based study. Clinical Nutrition, 2014(33): 521-527
Teuwafeu, D. G., Dongmo, A., Fomekong, S. D., Amougou, M., Mahamat, M., Nono, A., Kaze, F. F., & Ashuntantang, G. (2023). Acquired Cystic Kidney Disease in Patients On Maintenance Hemodialysis, Prevalence and Associated Factors: A Cross-Sectional Study. The Pan African Medical Journal, 45: 175.
Thomsen, R. W., Nicolaisen, S. K., Hasvold, P., Garcia-Sanchez, R., Pedersen, L., Adelborg, K., Egfjord, M., Egstrup, K., & Sørensen, H. T.(2018). Elevated Potassium Levels in Patients with Congestive Heart Failure: Occurrence, Risk Factors, and Clinical Outcomes: A Danish Population-Based Cohort Study. Journal of the American Heart Association, 7(11): 1-15
Walli-Attaei, M., Joseph, P., Johansson, I., Sliwa, K., Lonn, E., Maggioni, A. P., Mielniczuk, L., Ross, H., Karaye, K., Hage, C., Pogosova, N., Grinvalds, A., McCready, T., McMurray, J., Yusuf, S., & G-CHF investigators.(2024). Characteristics, Management, And Outcomes in Women And Men With Congestive Heart Failure In 40 Countries At Different Economic Levels: An Analysis From The Global Congestive Heart Failure (G-CHF) Registry. Lancet Global Health, 12(3): e396-e405
Yamada, S., & Inaba, M. (2021). Potassium Metabolism and Management in Patients With CKD. Nutrients, 13(6): 751.
Zaher, W., Della Rocca, D. G., Pannone, L., Boveda, S., de Asmundis, C., Chierchia, G. B., & Sorgente, A. (2024). Anti Arrhythmic Effects of Heart Failure Guideline-Directed Medical Therapy and Their Role in the Prevention of Sudden Cardiac Death: From Beta-Blockers to Sodium-Glucose Co-transporter 2 Inhibitors and Beyond. Journal of Clinical Medicine, 13(5): 1316.
Copyright (c) 2025 JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
1. The copyright of this journal belongs to the Editorial Board and Journal Manager with the author's knowledge, while the moral right of the publication belong to the author.
2. The formal legal aspect of journal publication accessibility refers to the Creative Commons Attribution-Non-Commercial-Share Alike (CC BY-NC-SA), which implies that the publication can be used for non-commercial purposes in its original form.
3. Every publication (print/electronic) is open access for educational, research, and library purposes. In addition to the objectives mentioned above, the editorial board is not responsible for copyright infringement