The Effect of Sacubitril/Valsartan Treatment on Cardiac and Renal Functions of a Patient With Cardiorenal Syndrome Type 4 and Stage 5 CKD After More Than Three Years of Follow-Up

Abstract

It is difficult to treat cardiorenal syndrome (CRS) in clinical practice, which is the common reason for the death of patients. This report aimed to describe the effects of sacubitril/valsartan treatment on cardiac and renal functions of a patient with cardiorenal syndrome type 4 (CRS4) after more than 3 years of follow-up. A 77-year-old Chinese woman was admitted to our hospital because of CRS4 and stage 5 chronic kidney disease (CKD), who had a history of long-term proteinuria and renal failure. The patient's cardiothoracic ratio (CTR) measured by chest X–ray was 0.6. Cardiac ultrasonography showed that the left ventricular ejection fraction (LVEF) was 0.40. The patient had been treated for heart failure (HF) for 5 months, but there was no improvement in clinical manifestations, and the renal function gradually deteriorated. In our hospital, she received sacubitril/valsartan treatment for at least 40 months. The symptoms of HF relieved, and the indices of cardiac function improved. In addition, the patient's renal function was stable. During the treatment, the dosage of sacubitril/valsartan needed to be adjusted to achieve the optimal therapeutic effect. Follow-up results showed that she achieved cardiac function of New York Heart Association (NYHA) class II with an ejection fraction of 0.60 and E/A > 1 indicated by echocardiogram, and did not develop hyperkalemia. In summary, the improvement of cardiac and renal functions of the CRS4 patient was associated with the long-term sacubitril/valsartan treatment.

Emodin alleviates CRS4‐induced mitochondrial damage via activation of the PGC1α signaling

“…CRS4 is related to adverse cardiac structural remodeling and functional deficits, which eventually result in heart failure (HF) and even death (Cicoira et al, 2011). Despite receiving therapy using traditional HF medications, cardiovascular mortality rates continue to increase steadily in patients with CRS4 (Cheng et al, 2022). Therefore, there is an urgent need to explore novel strategies for the treatment of CRS4.…”

Effect of sacubitril/valsartan on lipid metabolism in patients with chronic kidney disease combined with chronic heart failure: a retrospective study

“…Sacubitril/valsartan exerts its influence on the glomerular filtration rate by expanding the small incoming arterioles while constricting the small outgoing arterioles. Additionally, it enhances the activity of the NP system, fostering cardiac improvement through the cGMP pathway, coupled with an elevation in renal perfusion [ 48 ]. Multicenter randomized trials have demonstrated sacubitril/valsartan’s potential to diminish the risk of renal deterioration in people with HF, whether they had HFrEF or HFpEF [ 49 ].…”

Panax notoginseng saponins inhibits NLRP3 inflammasome-mediated pyroptosis by downregulating lncRNA-ANRIL in cardiorenal syndrome type 4

“…Cardiorenal syndrome (CRS) is a complex pathophysiological disease of heart and kidney, in which dysfunction of one usually induces injury of the other [ 1 ]. The association between chronic kidney disease (CKD) and the following chronic cardiovascular disease has been defined as CRS type 4 (CRS4), which is the progression of cardiac failure and cardiac complications in patients with CKD [ 2 , 3 ].…”

“…Several treatments for cardiovascular and renal diseases have been proven significant in clinical. However, the treatment of CRS4 is still a major challenge, because some drugs showing efficiency in one organ failure may worsen the function of the other [ 1 ]. Therefore, it is essential to explore CRS4 in depth and find novel treatment strategies for it.…”