Sacubitril-Valsartan Improves Anemia of Cardiorenal Syndrome (CRS)

Abstract

Background and Aims: Anemia is a common complication of heart failure and chronic kidney disease (CKD). Sacubitril-valsartan is a novel therapy for the treatment of chronic heart failure with a reduced ejection fraction (HFrEF). We have evaluated the short-term effects of sacubitril-valsartan on the anemia of CRS. Methods: The study group comprised 39 patients with HFrEF, who were followed-up for three months. The study is a retrospective analysis of clinical data. Data of 3 months’ visit and baseline visit were recorded including: plasmatic creatinine, glomerular filtration rate, cystatin C, kaliemia, haemoglobin, pro-BNP and albuminuria. Results: In all, 34 patients ended the follow-up. Mean sacubitril-valsartan dosage at baseline was 101±62 mg/day and 126±59 mg/day at end. Mean hemoglobin increased from 12.2±1.1 g/dl at baseline to 12.9±1.0 g/dl (p = 0.001,). Prevalence of anemia was 64.7% (95%CI,47.9-78.5%) at baseline and 38.4 (95%CI,23.9-55.0%) after the follow-up (p = 0.016). Serum cystatin C levels decreased from 2.71±1.0 to 2.48±1.0 mg/l (p = 0.028). Serum K levels remained unchanged (baseline 4.94±0.60, three months visit 4.94±0.61 mmol/l, p = 0.998). Conclusions: Sacubitril-valsartan improves anemia in CRS patients. An improvement of serum cystatin levels was observed. Few untoward effects were detected. These findings should be confirmed in wider clinical trials.

Prevalence of, association with, severity of, and prognostic role of serum hemoglobin level in acutely decompensated heart failure patients

“…Also, several mechanisms are considered for ACEI/ARBs, and some BBs, including carvedilol, inhibit erythropoiesis [ 28 – 30 ]. However, recent studies reported that sacubitril/valsartan (Neprilysin/Angiotensin Receptor Inhibitor) reduces anemia in patients with CRS [ 31 , 32 ]. MRAs may induce erythropoiesis by down-regulating hepcidin.…”

Fatores preditivos para o desenvolvimento da síndrome cardiorrenal em pacientes com insuficiência cardíaca

“…O risco de mortalidade associado com a SCR é mais proeminente no início do quadro, mas pode perdurar ao longo da manifestação das consequências clínicas de forma que, quanto mais grave for o quadro de injúria renal, piores serão os possíveis desfechos renais e cardíacos. Distúrbios correlacionados no organismo são compartilhados pelo coração e pelos rins, tais como inflamação e disfunção endotelial celular, resultando em um declínio da função de ambos os órgãos (Al-Hwiesh et al, 2019;Robles et al, 2020).…”

“…Essa categoria de alto risco esteve mais relacionada com um preditor independente para readmissão hospitalar devido à insuficiência cardíaca e mortalidade. O desenvolvimento de anemia em pacientes que se apresentam com insuficiência cardíaca e desenvolvem síndrome cardiorrenal e a redução da fração de ejeção do ventrículo esquerdo com disfunção renal podem ser considerados fatores preditivos para o desenvolvimento da síndrome cardiorrenal (Suresh et al, 2017;Al-Jarallah et al, 2019;Robles et al, 2020).…”

Iron deficiency states in cardiovascular diseases: impact on prognosis and features of correction

“…в ретроспективном анализе базы данных было показано, что исходная распространённость анемии составила 64,7%, а через три месяца лечения сакубитрилом/валсартаном -38,4% (p=0,016), что коррелировало со снижением уровня ци-статина с в сыворотке. авторы указывают, что эти результаты получены у пациентов с хсн и сопутствующей хбп и должны быть подтверждены в более широких клинических испытаниях [23]. заслуживают внимания данные о том, что препараты из класса ингибиторов натрийглюкозного котранспортера 2 типа (инглт2) повышают гематокрит и могут корректировать анемию у пациентов с хсн [24].…”