Effects of sacubitril-valsartan in patients undergoing maintenance dialysis

Abstract

: Objectives Data on angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril-valsartan (SV) in patients undergoing maintenance dialysis is scarce. Our study aimed to investigate the effect of SV on patients undergoing dialysis. Methods We retrospectively reviewed the data of end-stage kidney disease (ESRD) patients undergoing either peritoneal dialysis (PD) or hemodialysis (HD) in our center. A total of 51 patients receiving SV treatment were enrolled in the SV group. Another 51 age and sex-matched patients on dialysis without SV treatment were selected as the control group. All the patients were regularly followed up in the dialysis clinic. Their clinical, biochemical, and echocardiographic parameters were all recorded at baseline and during follow-up. The effect and safety of SV were further analyzed. Results A total of 102 ESRD patients on dialysis (51 patients in the SV group and 51 patients in the control group) were finally enrolled. The median follow-up time was 349 days (interquartile range [IQR]: 217–535 days). The level of B-type natriuretic peptide (BNP) (median [IQR] before and after SV treatment: 596.35 pg/ml [190.6–1714.85] vs. 188.7 pg/ml [83.34–600.35], p < 0.001) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) (median [IQR]: 6316.00 pg/ml [4552.00–28598.00] vs. 5074.00 pg/ml [2229.00–9851.00], p = 0.022) were significantly decreased after treatment with SV. The variant rate of left ventricular ejection fraction (LVEF) was significantly higher in the SV group compared to the control group, especially in the PD subgroup. No significant difference was found in other echocardiographic parameters between SV and control group. Subgroup analysis of the PD group showed an increase in daily PD ultrafiltration (median [IQR]: 400 ml/d [200-500] vs. 500 ml/d [200–850], p = 0.114) after SV treatment. Variant rate of overhydration (OH) measured by the body composition monitor (BCM) of the SV group were significantly different from the control group (median [IQR]: −13.13% [−42.85%–27.84%] vs. 0% [−17.95%–53.85%], p = 0.049). The rate of hyperkalemia was slightly higher but without significant difference before and after the introduction of SV (19.6% vs. 27.5%, p = 0.350). No event of hypotension and angioedema were observed. Conclusions SV might have a cardio-protective role in ESRD patients undergoing dialysis, especially in PD patients. Serum potassium should be monitored during the treatment.

Effect of Sacubitril/Valsartan on Patients Having Heart Failure With Preserved Left Ventricular Ejection Fraction Undergoing Hemodialysis: A Long-term Observational Study

“…Studies have reported that echocardiographic parameters after SV initiation did not improve; however, the rate of improvement in LVEF was higher in the SV group than in the control group (26,27). This study has several limitations.…”

Incidence of hyperkalemia in anuric hemodialysis patients treated with sacubitril/valsartan

“…Three of the above studies reported side effects of hyperkalemia, with one study finding that sacubitril/valsartan did not increase serum potassium levels (4.6 ± 0.8 to 4.5 ± 0.7 mmol/L, p = 0.765) 13 . Ding et al, 10 reported a slightly higher, yet non‐significant, rate of hyperkalemia following sacubitril/valsartan therapy (19.6% vs. 27.5%, p = 0.350). Wang B et al 14 observed no hyperkalemia following sacubitril/valsartan therapy.…”

“…Lee et al 9 reported the efficacy and safety of sacubitril/valsartan in 23 patients with heart failure undergoing hemodialysis treatment, noting a reduction in serum troponin T levels and an improvement in left ventricular heart function after a follow‐up period of 4 months. A retrospective cohort study showed that sacubitril/valsartan can reduce the levels of B‐type natriuretic peptide and N‐terminal pro‐B‐type natriuretic peptide 10 . A prospective before‐and‐after study found that sacubitril/valsartan‐based therapy significantly reduced mean sitting systolic and diastolic blood pressure as well as improved cardiac remodeling parameters 14 .…”

“…Lee et al 9 reported sacubitril/valsartan effectively lowers high‐sensitivity troponin T levels and improves left ventricular ejection fraction in reduced ejection fraction heart failure patients with end‐stage renal disease (ESRD) on regular hemodialysis. Furthermore, sacubitril/valsartan was found to be effective in ESRD patients undergoing dialysis, particularly peritoneal dialysis patients, likely playing a cardio‐protective role 10 . Unfortunately, reports regarding the effect of sacubitril/valsartan on serum potassium concentrations in anuric patients undergoing hemodialysis treatment are limited.…”

Hiệu Quả Hạ Huyết Áp Của Sacubitril/Valsartan Ở Bệnh Nhân Lọc Máu Ngoài Thận Có Tăng Huyết Áp: Kết Quả Từ Nghiên Cứu Phân Tích Gộp

“…Tổng cộng có 7 nghiên cứu với 447 bệnh nhân, thời gian công bố từ 2021 -2023, đã được đưa vào phân tích gộp (Bảng 1). 3,[6][7][8][9][10][11] Chú thích: :không được báo cáo; X ̄: trung bình; median: trung vị; SD: độ lệch chuẩn; IQR: khoảng tứ phân vị.…”