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

Abstract

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.

Systematic Review of Cardiovascular Benefits and Safety of Sacubitril-Valsartan in End-Stage Kidney Disease

“…, 34 2022 China 2020–2021 Retrospective, observational self-controlled study 50–200 mg/day 6 mo 54 Mean 50.9 (SD 14.6) 29 (53%) HD HFrEF, LVEF <40% B-blocker: n = 51 Zhang et al. , 35 2022 China 2020–2021 Retrospective, observational self-controlled study 100 mg twice a day 7 d 47 Mean 45.9 (SD 12.4) 28 (60%) PD Nonspecified Hypertension: n = 42, Diabetes, n = 10 ACEI/ARB: n = 27, Diuretic: n = 12 Zhao et al. , 36 2022 China 2019–2021 Retrospective, observational cohort study 100 mg twice a day 3 mo 122 Mean 49.13 (SD 15.4) 75 (75%) HD Nonspecified Hypertension: n = 69, Diabetes: n = 17, CAD: n = 13 ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CAD, coronary artery disease; d, day; HD, hemodialysis; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection; IQR, interquartile range; LVEF, left ventricular ejection fraction; MCA, mineralocorticoid antagonist; mo, month; PD, peritoneal dialysis.…”

“…Unfortunately, data from Zhang et al. 35 was not sufficient for the analysis of LVEF changes. As depicted in Supplementary Figure S1 , our analysis revealed no significant difference between the HD and PD groups ( P = 0.76).…”

Effects of sacubitril‐valsartan in the treatment of chronic heart failure patients with end‐stage renal disease undergoing dialysis

“…Therefore, increasing attention has been paid to the role of ARNI in HF patients complicated with CKD. For ESRD in dialysis patients, a study had shown that LCZ696 treatment can increase short‐term peritoneal ultrafiltration in PD patients, but did not increase 24 h urine volume, which demonstrated the role of LCZ696 in water removal and BP control in PD patients 17 . Therefore, it is possible for LCZ696 to play a beneficial role in CHF patients with ESRD on dialysis in clinical treatment.…”

Effects of sacubitril-valsartan in patients undergoing maintenance dialysis

“…Zhang F et al. conducted a short-term observation of the effect of SV on peritoneal ultrafiltration and found that SV increased ultrafiltration by 66.4 mL/24h in PD patients within 7 days after its use [ 26 ]. Our study had similar results, and moreover, we had a much longer follow-up time which proved that the effect of SV on increasing peritoneal ultrafiltration was sustainable.…”

“…It is distributed ubiquitously in the tissue including epithelia, fibroblasts, and kidney and it could also be in the soluble form in the plasma [ 27 , 28 ]. Since the peritoneum is covered by epithelium and rich in the vasculature, the inhibition of neprilysin in PD patients might result in the dilation of blood vessels, which might help increase the peritoneal ultrafiltration [ 26 ]. But the exact mechanism involved requires further exploration.…”