Effects of Sacubitril/Valsartan Versus Irbesartan in Patients With Chronic Kidney Disease

Haynes, Richard; Judge, Parminder; Staplin, Natalie; Herrington, William G.; Storey, Benjamin C.; Bethel, Angelyn; Bowman, Louise; Brunskill, Nigel J.; Cockwell, Paul; Hill, Michael; Kalra, Philip A.; McMurray, John J.V.; Taal, Maarten W.; Wheeler, David C.; Landray, Martin J; Baigent, Colin

doi:10.1161/circulationaha.118.034818

Cited by 182 publications

(162 citation statements)

References 46 publications

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“…4 The tolerability and safety profiles of the two treatments were not different. The UK HARP-III trial (United Kingdom Heart and Renal Protection-III) has demonstrated that, in a wide range of people with proteinuric chronic kidney disease, adding neprilysin inhibition to angiotensin II receptor blockade has no additional effect on kidney function or albuminuria compared with irbesartan.…”

Section: Discussionmentioning

confidence: 94%

“…The UK HARP-III trial (United Kingdom Heart and Renal Protection-III) has demonstrated that, in a wide range of people with proteinuric chronic kidney disease, adding neprilysin inhibition to angiotensin II receptor blockade has no additional effect on kidney function or albuminuria compared with irbesartan. 4 The tolerability and safety profiles of the two treatments were not different. However, compared with irbesartan, sacubitril/valsartan further reduces both blood pressure and biomarkers of cardiovascular risk (Troponin I and N-terminal pro-B-type natriuretic peptide) and raises the hypothesis that ARNI could reduce cardiovascular morbidity and mortality in a heart failure population with chronic kidney disease.…”

Section: Discussionmentioning

confidence: 94%

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Sacubitril/valsartan in heart failure and end‐stage renal insufficiency

Heyse¹,

Manhaeghe²,

Mahieu³

et al. 2019

ESC Heart Failure

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The aim of this report is to describe the feasibility and tolerability of medical treatment with sacubitril/valsartan in a patient treated with hemodialysis. We describe the case of a 67-year-old man with heart failure with reduced ejection fraction due to an ischemic cardiomyopathy and renal insufficiency undergoing hemodialysis. Because of worsening heart failure with no other therapeutic options, a treatment with sacubitril/valsartan was started. Although this patient had a very low systolic blood pressure, he could tolerate a moderate dose of 49/51 mg twice daily. After initiation of sacubitril/valsartan, there was a symptomatic improvement with a clear reduction NT-proBNP, accompanied by a decrease in filling pressures. In conclusion, in this patient with severe heart failure undergoing hemodialysis, treatment with sacubitril/valsartan was feasible, safe, and improved heart failure symptoms.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Sacubitril/valsartan in heart failure and end‐stage renal insufficiency

Heyse¹,

Manhaeghe²,

Mahieu³

et al. 2019

ESC Heart Failure

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“…Nevertheless, renal adverse events are observed frequently during clinical practice, when treating patients with angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) 5 . Neprilysin (NEP or neutral endopeptidase) is the enzyme responsible for the degradation of natriuretic peptides (NPs), as well as other mediators, such as bradykinin or adrenomedullin 6‐8 . Neprilysin inhibition (NEPi) is capable of activating RAS without breaking down angiotensin II or altering blood pressure (BP).…”

Section: What Is Known and Objectivementioning

confidence: 99%

Renal safety and efficacy of angiotensin receptor‐neprilysin inhibitor: A meta‐analysis of randomized controlled trials

et al. 2020

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What is known and objective Angiotensin receptor‐neprilysin inhibitor (ARNi) therapy has been shown to improve cardiovascular outcomes in the Prospective Comparison of ARNi with angiotensin‐converting enzyme inhibitor to Determine the Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM‐HF) study. However, the renal safety and efficacy of ARNi remains controversial. This meta‐analysis aimed to assess the renal safety and efficacy of angiotensin receptor‐neprilysin inhibitor (ARNi). Methods and Results PubMed, EMBASE, the Cochrane Library, Web of Science and Clinicaltrials.gov were searched for randomized controlled trials. Eleven studies that covered 21,716 patients were included. ARNi was superior to angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, in terms of risk of renal dysfunction, estimated glomerular filtration rate (eGFR) decline and elevated serum potassium levels, and higher risk of increase in urine albumin‐to‐creatinine ratio. However, there was no difference in the probability of hyperkalemia and elevated serum creatinine levels. The incidence of eGFR decrease in patients with chronic kidney disease (CKD) was lower in patients who received ARNi, although ARNi use was not associated with higher risk of renal dysfunction in patients with CKD. What is new and conclusion. Available evidence supports the effectiveness of ARNi on improving renal outcome. Compared with renin‐angiotensin‐aldosterone system inhibition, ARNi protects against renal impairment, since ARNi users have a lower risk of renal dysfunction and a higher eGFR, without an increased risk of hyperkalemia. However, its benefit for CKD patients still warrants further investigation.

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“…It also has been shown the weak correlation with BUN and no correlation with Scr, eGFR-MDRD for early diagnosis of DN, and the results are consistant with the past finding. 12 And indicated the decreased BF and prolong MTT in the CT perfusion imaging of early DN, and reflected the increase of renal artery resistance, the changes of renal artery morphology and renal cortex perfusion, and the evaluation of glomerular filtration rate.…”

Section: Discussionmentioning

confidence: 99%

“…Research showed that the renal cortex and medulla blood flow perfusion are damaged in hypertensive and diabetic nephropathy renal altered function, and the amount of blood perfusion of renal cortex is a direct index to judge the renal blood flow [12]. CT perfusion imaging was a proposed method in the early 90th century, and it can evaluate accurately renal function for clinical reference with clear anatomical image.…”

Section: Discussionmentioning

confidence: 99%

Significance of Renal Perfusion Angiography and Biochemical Indicators in Early Diagnosis of Type 2 Diabetic Nephropathy

Liang¹,

Lü²,

Liu³

et al. 2019

PLM

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Background: Although there are many biochemical indicators to reflect changes in renal function, but these indicators can not reflect renal damage timely and accurately. Renal microcirculation changes can not be reflected also. This study amied at evaluate significance of renal perfusion angiography and the indexes of relevant biochemical in early diagnosis of type 2 diabetic nephropathy. Methods: 30 I-III T2DN patients (DN group) and 25 healthy volunteers (control group) were studied, and both of groups were performed renal perfusion CT angiography imaging examination. Biochemical indexes, which are fasting blood glucose (FBG), urinary albumin excretion rate (UAE), 24 h urine protein quantitation (UPQ), blood urea nitrogen (BUN), serum creatinine (Scr), Cystatin C(Cys C), random albumin to creatinine ratio(ACR), were measured in both of groups, then simplified MDRD (Modification of Diet in Renal Disease) and Cys C equation were used to calculate the Estimated Glomerular Filtration Rate(eGFR). double-renal perfusion contrast scanning in both of groups were also conducted to obtain data of double renal blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) for statistical analysis. Results: The indexes of BF, MTT and FBG, UAE, 24 h UPQ, ACR, Cys C, eGFR were found to have relative strong correlation and statistical significance (P<0.05). BF was shown the negative correlation with those indexes, however MTT had positive correlation with them. The area under ROC (receiver operating characteristic curve), were more than 0.9 for UAE, ACR, NF, and MTT, and it indicate that these indexes have relatively positive effect on the early diagnosis of the DN. For 24 h UPQ, cysteine C, eGFR and BV value, the area Under the curve are between 0.7 and 0.9, which indicates that diagnosis using those index for the disease were accuracy. Thus, the above indexes have better diagnostic efficiency compared to Scr, BUN and eGFR. Conclusion: The biochemical indexes such as UAE, ACR and renal perfusion indexes such as BF and MTT can be applied in the early predicative diagnosis and DN screening. Its diagnosis effect is better than other biochemical indexes.

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Effects of Sacubitril/Valsartan Versus Irbesartan in Patients With Chronic Kidney Disease

Abstract: URL: http://www.isrctn.com . Unique identifier: ISRCTN11958993.

Cited by 182 publications

References 46 publications

Sacubitril/valsartan in heart failure and end‐stage renal insufficiency

Sacubitril/valsartan in heart failure and end‐stage renal insufficiency

Renal safety and efficacy of angiotensin receptor‐neprilysin inhibitor: A meta‐analysis of randomized controlled trials

Significance of Renal Perfusion Angiography and Biochemical Indicators in Early Diagnosis of Type 2 Diabetic Nephropathy

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