Effects of Sacubitril-Valsartan in Heart Failure With Preserved Ejection Fraction in Patients Undergoing Peritoneal Dialysis

Fu, Sha; Xu, Zhenjian; Lin, Baojuan; Chen, Junzhe; Huang, Qiuyan; Xu, Yuanyuan; Xu, Anping; Chen, Yangxin; Tang, Ying

doi:10.3389/fmed.2021.657067

Cited by 20 publications

(26 citation statements)

References 34 publications

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“…None of the PD patients showed adverse drug reactions such as hypotension, hyperkalaemia, or angioedema (Table 3). These data were similar to those reported by Tang et al (8), but seemed to be lower than those reported in HF population (Table 3) (6).…”

Section: Safety Of Sacubitril-valsartansupporting

confidence: 91%

“…Extra fluid removal of ARNI might contribute to cardiac function protection in PD population. At present, more studies have proved the role of sacubitrilvalsartan on cardiac function (6)(7)(8)(9), which might be the potential mechanism for better PUF. However, obvious improvement of cardiac function could be generally detected 1-3 months or even longer after ARNI application (41,42).…”

Section: Discussionmentioning

confidence: 99%

“…In PARADIGM-HF (Prospective Comparison of ARNI with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) study, sacubitril-valsartan led to significantly lower all-cause and cardiovascular mortality of heart failure with reduced ejection fraction (HFrEF) compared to enalapril alone (6). Subsequent researches on ARNI also confirmed this (7)(8)(9). In addition, sacubitril-valsartan plays an important role in antihypertension (10)(11)(12)(13)(14) and renal protection, regardless of baseline renal function (15).…”

Section: Introductionmentioning

confidence: 92%

“…Recently, sacubitril-valsartan was applied in advanced chronic kidney disease (CKD) patients (stage IV or V) with HFrEF in a real-world clinical setting, and the positive results were supported by lower overall mortality, cardiovascular death, and re-hospitalization (9). In addition, Tang et al (8) had undertaken a cohort study focused on peritoneal dialysis (PD) patients with HFpEF (HF with preserved ejection fraction). Of the 21 patients analyzed at last, HF was greatly improved after sacubitril-valsartan administration, not only in clinical signs and symptoms, but also in biochemical indicators.…”

Section: Introductionmentioning

confidence: 99%

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Sacubitril-Valsartan Increases Ultrafiltration in Patients Undergoing Peritoneal Dialysis: A Short-Term Retrospective Self-Controlled Study

Zhang

Yang

et al. 2022

Front. Med.

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AimThere are few data about the effectiveness and safety of angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril-valsartan in end-stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD). The present study was conducted to evaluate the association between sacubitril-valsartan treatment and peritoneal ultrafiltration (PUF) in PD patients.Methods and ResultsForty-seven ESRD patients undergoing PD for at least 3 months without severe congestive heart failure (CHF) were included in this study. Sacubitril-valsartan (generally 100 mg b.i.d) was administered after consultation with the nephrologist. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) were required to be discontinued 36 h before prescribing sacubitril-valsartan. Other treatments and dialysis modality did not change. Baseline demographic and clinical parameters were collected before ARNI administration, and daily PUF, urine volume, total output, blood pressure (BP), and body weight were collected within 7 days before and after ARNI treatment. After treated with sacubitril-valsartan, 30 patients (63.8%) had a significant increase of PUF [up to 150.4 (110.7, 232.1) ml per day], while the remaining 17 (36.2%) had a slight decrease. The overall increase of PUF was 66.4 (21.4, 123.2) ml/24 h within the 7 days after sacubitril-valsartan administration, which was significantly higher than those before (P = 0.004). Total output, BP, and body weight also significantly improved. No adverse drug reactions were observed.ConclusionsOur study indicated that sacubitril-valsartan was associated with the increase of short-term PUF and total output in PD patients.

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Section: Safety Of Sacubitril-valsartansupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sacubitril-Valsartan Increases Ultrafiltration in Patients Undergoing Peritoneal Dialysis: A Short-Term Retrospective Self-Controlled Study

Zhang

Yang

et al. 2022

Front. Med.

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“…A clinical study conducted in hemodialysis patients in China showed that, when ARNI 100 mg BID was used to treat hemodialysis patients with HFrEF or heart failure with midrange ejection fraction, the maximum blood concentration of LBQ657 was within the safe drug concentration range, and ARNI effectively improved their left ventricular ejection fraction (P < 0.05) (75). Another retrospective study including 23 patients also confirmed that ARNI could improve the left ventricular ejection fraction and myocardial marker levels in dialysis patients with HFrEF (76). A Chinese study including 21 peritoneal dialysis patients with HFpEF confirmed that ARNI could also significantly improve the symptoms and signs of heart failure and reduce the levels of heart failure markers, while also exhibiting a tendency to improve cardiac function (77).…”

Section: Arni In Patients With Ckd Undergoing Maintenance Dialysis (H...mentioning

confidence: 83%

Application of Angiotensin Receptor–Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

Gan

Lyu²,

Yang³

et al. 2022

Front. Med.

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Chronic kidney disease (CKD) is a global public health problem, and cardiovascular disease is the most common cause of death in patients with CKD. The incidence and prevalence of cardiovascular events during the early stages of CKD increases significantly with a decline in renal function. More than 50% of dialysis patients die from cardiovascular disease, including coronary heart disease, heart failure, arrhythmia, and sudden cardiac death. Therefore, developing effective methods to control risk factors and improve prognosis is the primary focus during the diagnosis and treatment of CKD. For example, the SPRINT study demonstrated that CKD drugs are effective in reducing cardiovascular and cerebrovascular events by controlling blood pressure. Uncontrolled blood pressure not only increases the risk of these events but also accelerates the progression of CKD. A co-crystal complex of sacubitril, which is a neprilysin inhibitor, and valsartan, which is an angiotensin receptor blockade, has the potential to be widely used against CKD. Sacubitril inhibits neprilysin, which further reduces the degradation of natriuretic peptides and enhances the beneficial effects of the natriuretic peptide system. In contrast, valsartan alone can block the angiotensin II-1 (AT1) receptor and therefore inhibit the renin–angiotensin–aldosterone system. These two components can act synergistically to relax blood vessels, prevent and reverse cardiovascular remodeling, and promote natriuresis. Recent studies have repeatedly confirmed that the first and so far the only angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan can reduce blood pressure more effectively than renin–angiotensin system inhibitors and improve the prognosis of heart failure in patients with CKD. Here, we propose clinical recommendations based on an expert consensus to guide ARNI-based therapeutics and reduce the occurrence of cardiovascular events in patients with CKD.

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Sacubitril-Valsartan in Patients Requiring Hemodialysis

Le,

Grams,

Coresh

et al. 2024

JAMA Netw Open

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ImportanceRandomized clinical trials have shown that sacubitril-valsartan reduces the risks of mortality and hospitalization in patients with heart failure with reduced ejection fraction (HFrEF), but patients with kidney failure requiring dialysis were excluded.ObjectiveTo investigate the comparative effectiveness of sacubitril-valsartan vs angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs or ARBs) in patients with HFrEF requiring hemodialysis.Design, Setting, and ParticipantsThis retrospective, 1:1 propensity score–matched comparative effectiveness study included patients who were 18 years or older with HFrEF, enrolled in Medicare Parts A, B, and D, and survived at least 90 days receiving in-center hemodialysis from July 8, 2015, to December 31, 2020. Patients were excluded for less than 180 days of continuous Medicare Parts A, B, and D primary payer coverage or prior dispensing of sacubitril-valsartan. Data analysis was conducted from September 23, 2023, to June 25, 2024.ExposuresNew use of sacubitril-valsartan vs new or continued use of ACEIs or ARBs.Main Outcomes and MeasuresThe associations between initiation of sacubitril-valsartan therapy and all-cause mortality, cardiovascular mortality, all-cause hospitalization, and HF hospitalization were assessed using Cox proportional hazards regression models in a propensity score–matched sample.ResultsParticipants included 1:1 matched pairs of 1434 sacubitril-valsartan users and 1434 ACEI or ARB users (mean [SD] age, 64 [13] years). Of the 2868 matched participants, 996 (65%) were male; 987 (34%) were Black or African American and 1677 (58%) were White; and median dialysis vintage was 3.8 (IQR, 1.8-6.3) years. The median follow-up was 0.9 (IQR, 0.4-1.7) years. Sacubitril-valsartan (vs ACEI or ARB) therapy was associated with a reduction in all-cause mortality (hazard ratio [HR], 0.82 [95% CI, 0.73-0.92]) and all-cause hospitalization (HR, 0.86 [95% CI, 0.79-0.93]) but not cardiovascular mortality (HR, 1.01 [95% CI, 0.86-1.19]) or HF hospitalization (HR, 0.91 [95% CI, 0.82-1.02]). There was a decrease in hyperkalemia (HR, 0.71 [95% CI, 0.62-0.81]) and no difference in hypotension (HR, 0.99 [95% CI, 0.83-1.19]). Only 195 participants (14%) ever received the maximum combination dose of sacubitril (97 mg twice daily) and valsartan (103 mg twice daily).Conclusions and RelevanceIn this comparative effectiveness study of patients with HFrEF requiring hemodialysis, sacubitril-valsartan therapy was associated with beneficial effects in all-cause mortality and all-cause hospitalization.

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Effects of Sacubitril-Valsartan in Heart Failure With Preserved Ejection Fraction in Patients Undergoing Peritoneal Dialysis

Cited by 20 publications

References 34 publications

Sacubitril-Valsartan Increases Ultrafiltration in Patients Undergoing Peritoneal Dialysis: A Short-Term Retrospective Self-Controlled Study

Sacubitril-Valsartan Increases Ultrafiltration in Patients Undergoing Peritoneal Dialysis: A Short-Term Retrospective Self-Controlled Study

Application of Angiotensin Receptor–Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

Sacubitril-Valsartan in Patients Requiring Hemodialysis

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