Cardio-renal benefits of sacubitril/valsartan in patients with advanced chronic kidney disease: experience in daily clinical practice

• Published in: BMC nephrology Vol. 23; no. 1; pp. 1 - 293
• Main Authors: Martínez-Esteban, María Dolores, Vázquez-Sánchez, Teresa, Pozo-Álvarez, Rafael, Moreno-Ortiz, Alicia, Alonso-Titos, Juana, Martín-Reyes, Guillermo, Ruiz-Esteban, Pedro, Gaitán-Román, Daniel, Hernández, Domingo
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 23.08.2022; BioMed Central; BMC
• Subjects: Antihypertensives; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Chronic kidney disease; Chronic kidney failure; Clinical medicine; Complications and side effects; Congestive heart failure; Coronary artery disease; Creatinine; Diabetes; Diuretics; Dosage and administration; Drug dosages; Drug therapy; Ejection fraction; Emergency medical care; Enzymes; Etiology; Glomerular filtration rate; Heart diseases; Heart failure; Hemodynamics; Hypertension; Hypotension; Ischemia; Kidney diseases; Mortality; Nephrology; Neprilysin; Neprilysin inhibitor; Normal distribution; Patient outcomes; Patients; Peptides; Potassium; Proteinuria; Reduced ejection fraction; Renal failure; Risk factors; Statistical analysis; Valsartan; Ventricle; Spain
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-022-02919-z

Abstract Background The association between cardiac complications, such as heart failure (HF), and chronic kidney disease (CKD) is well known. In this study, we examined the effectiveness and safety of treatment with neprilysin inhibition in patients with advanced chronic kidney disease (stage 3b-4). Methods This single-centre, longitudinal, retrospective study of 31 months duration involved consecutive patients with CKD and HF with a reduced ejection fraction (HFrEF) who started treatment with sacubitril/valsartan. Glomerular filtration rate (GFR), cardiovascular risk factors, proteinuria, potassium, echocardiographic parameters and admissions for heart failure were analysed. Results The study comprised 25 patients with a median age of 73.2 ± 5.9 years. The most frequent aetiology of heart failure was ischemic heart disease. The median GFR was 29.4 ± 8.3 ml/min/1.73 m 2 and the left ventricular ejection fraction (LVEF) 36.4 ± 8.9%. The GFR improved after initiating the treatment (F = 3.396, p  = 0.019), as did the LVEF at one year of follow-up ( p  = 0.018). The number of visits to the emergency department for heart failure was also reduced. No patients needed to start renal replacement therapy. Conclusions This study shows that sacubitril/valsartan may play a beneficial role in patients who have advanced CKD and HFrEF, with a satisfactory safety profile.