Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World Experience

Abstract

Background: data regarding the effectiveness and safety of sacubitril/valsartan in heart failure and reduced ejection fraction (HFrEF) patients with chronic kidney disease (CKD) are scarse. Objective: to evaluate the effectiveness and safety of sacubitril/valsartan in HFrEF and CKD in a real-world population. Methods: we included consecutive ambulatory HFrEF patients that initiated sacubitril/valsartan between February 2017 and October 2020, stratified by CKD (KDIGO stage 5 excluded). Primary outcomes: the incidence rate per 100 patient-years and the annualized length of stay (LOS) of acute decompensated HF hospitalizations (HFH). Secondary outcomes: all-cause mortality, NYHA improvement, and titration of sacubitril/valsartan. Results: We included 179 patients, 77 with CKD, those being older (72 ± 10 vs. 65 ± 12 years, p < 0.001), had higher NT-proBNP (4623 ± 5266 vs. 1901 ± 1835 pg/mL, p < 0.001), and high anaemia incidence (p < 0.001). After 19 ± 11 months, a significant reduction in HFH adjusted incidence rate (57.5% decrease in CKD versus 74.6%, p = 0.261) was observed, with 5 days there was a reduction in annualized LOS in both groups (p = 0.319). NYHA improved similarly in both groups (p = 0.670). CKD patients presented non-significant higher all-cause mortality (HR = 2.405, 95%CI: [0.841; 6.879], p = 0.102). Both groups had similar sacubitril/valsartan maximum dose achievement and drug withdrawal. Conclusion: sacubitril/valsartan was effective on reducing HFH and LOS without affecting all-cause mortality in a CKD real-world population.

Assessing Hypotension Incidence and Dosing Strategies of Sacubitril/Valsartan in Real-World Heart Failure Management: Protocol for A Retrospective, Multicenter, Cohort Study (Preprint)

“…1 MGM New Bombay Hospital, Mumbai Navi Mumbai IN 2 Sir Ganga Ram Hospital, New Delhi New Delhi IN 3 Krish Heart Care, Ahemadabad Ahmedabad IN 4 Ramakrishna Medical Centre LLP(Heart Care Unit) Trichy Trichy IN 5 Aditya Health Clinics, Hyderabad Hyderabad IN 6 Sattur Heart Care, Hubli Hubli IN 7 Amri Hopsital, Salt lake, Kolkata Kolkata IN Please make my preprint PDF available only to logged-in users; I understand that my title and abstract will remain visible to all users. Only make the preprint title and abstract visible.…”

“…As per the 2022 American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America (ACC/AHA/HFSA) Focused Update on New Pharmacological Therapy for HF, ACEI, ARB, or angiotensin receptor neprilysin inhibitor (ARNi) are now advocated for patients with chronic symptomatic HFrEF to mitigate morbidity and mortality, receiving a class I recommendation (3). Sacubitril/valsartan is superior to enalapril in reducing the risks of cardiovascular death and preventing hospitalization in patients with HFrEF (4,5). The use of Sacubitril/Valsartan in HFrEF patients is associated with a significant reduction in blood pressure (BP) as compared to the ACEI/ARB group overall and across the eGFR spectrum, including in advanced chronic kidney disease (4,(6)(7)(8).The suggested initial dose of sacubitril/valsartan is 50 mg, to be taken orally twice daily.…”

Assessing hypotension incidence and dosing strategies of sacubitril/valsartan in real-world heart failure management: protocol for a retrospective, multicentre and cohort study

“…3 Sacubitril/valsartan is superior to enalapril in reducing the risks of cardiovascular death and preventing hospitalization in patients with HFrEF. 4,5 The use of sacubitril/valsartan in HFrEF patients is associated with a significant reduction in blood pressure (BP) as compared to the ACEI/ARB group overall and across the eGFR spectrum, including in advanced chronic kidney disease. 4,[6][7][8] The suggested initial dose of sacubitril/valsartan is 50 mg, to be taken orally twice daily.…”