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

Heart Failure Guideline-Directed Medical Therapy in End-Stage Kidney Disease: From PARADIGM-HF to Clinical Practice

“…However, the work of Charkviani et al. 2 also suggests that sacubitril/valsartan may result in an improvement of left ventricular ejection fraction in patients with impaired systolic function, in line with the evidence available in the broader population with HF.…”

“…In conclusion, the study by Charkviani et al. 2 offers a meaningful addition to the ongoing debate regarding HF management within the context of ESKD. For the cardiology and nephrology communities, the objective remains to substantiate the initial findings of this meta-analysis with larger trials that could eventually provide more definitive guidance on the use of sacubitril/valsartan and other HF therapies in ESKD.…”

“…In this issue of Kidney International Reports, the study by Charkviani et al. 2 emerges as a commendable attempt to explore the role of sacubitril/valsartan beyond the well-charted territories defined by the landmark PARADIGM-HF and PARAGON-HF trials. 3 , 4 These foundational studies have positioned sacubitril/valsartan as a cornerstone in the management of HF.…”

“…From the analysis of Charkviani et al. , 2 the lack of safety data in the literature clearly emerges as a major limitation preventing a more widespread use of sacubitril/valsartan in ESKD. Of the 12 included studies, only 3 compared the rates of hyperkalemia between sacubitril-valsartan and a control group, and only 2 addressed hypotension.…”

“…Building upon the work of Charkviani et al. 2 and the insights from PARADIGM-HF and PARAGON-HF, future studies on sacubitril/valsartan should enroll primarily patients with reduced ejection fraction, targeting measurable improvements in systolic function and monitoring key safety indicators such as hyperkalemia and hypotension.

Figure 1 Heart failure guideline-directed medical therapy in end-stage kidney disease: advancing the evidence.

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