The Effect of Sacubitril/Valsartan in a Dialysis Patient with Severe Heart Failure

Abstract

Heart failure (HF) is a major comorbidity in patients with end-stage renal disease (ESRD). The pathogenesis of HF in patients on renal replacement therapy represents the confluence of several traditional and nontraditional vascular risk factors, unique to the milieu of chronic kidney disease and the dialysis modality [1]. The purpose of this report is to describe the efficacy and safety of sacubitril/valsartan for an ESRD patient on hemodialysis therapy conmbined with heart failure with reduced ejection fraction (HFrEF). A 35-year-old woman was undergoing hemodialysis due to ESRD and suffering from heart failure with reduced ejection fraction. Because of worsening heart failure and hypertension, she was prescribed with sacubitril/valsartan at a dose of 50 mg twice a day, spironolactone at a dose of 20 mg three times a day and metoprolol at a dose of 23.75 mg once daily. There was a symptomatic improvement with the heart failure and reduction in NT-proBNP level, accompanied by a decrease of blood pressure after using sacubitric/valsartan. In conclusion, it is safe and effective to take sacubitril/valsartan in this hemodialysis patient with severe heart failure.

Sacubitril/Valsartan Improves Cardiac Function in Dialysis Patients

“…There was no difference in chronic renal events (OR 0.92 (0.8-1.05)) or hyperkalemia (OR 1.02 (0.84-1.23)), suggesting that neutral endopeptidase inhibitors (NEPi)+ ACEi/ARBs have a safe record at the renal level. In line with our findings, Kong et al [ 14 ] demonstrated that administration of Sac/Val (50 mg twice a day) for one year improved the symptoms of HF and reduced NT-proBNP levels, accompanied by a decrease in blood pressure in a single HD patient with HFrEF. Although the authors attributed these cardiac beneficial effects to Sac/Val, it should be emphasized that the drug was given along with spironolactone at a dose of 20 mg three times a day and metoprolol at a dose of 23.75 mg once daily.…”