ARNI of benefit in HF patients with CKD

Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), has shown favourable cardiac and renal ef­fects in patients with heart failure (HF) and chronic kidney dis­ease (CKD) in a recent meta-analysis.

The meta-analysis included six randomized controlled trials (RCTs) and eight observational studies, which involved a total of 17,335 patients with HF and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² treated with sacubitril/val­sartan or controls (valsartan, enalapril, conventional treatment for HF, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, or no ARNI treatment). Results showed that sacubitril/valsartan significantly reduced the risk of cardiovas­cular death or HF hospitalization in patients with HF and stage 3–5 CKD (odds ratio [OR], 0.65; 95 percent confidence inter­val [CI], 0.54–0.78), and prevented serum creatinine elevation (OR, 0.81; 95 percent CI, 0.68–0.95), eGFR decline (OR, 0.83; 95 percent CI, 0.73–0.95), as well as development of end-stage renal disease (ESRD; OR, 0.73; 95 percent CI, 0.60– 0.89) compared with controls. [Ren Fail 2024;46:2349135]

In terms of safety, sacubitril/valsartan was not asso­ciated with increased rates of hyperkalaemia (OR, 1.31; 95 percent CI, 0.79–2.17) or hypotension (OR, 1.57; 95 percent CI, 0.94–2.62) compared with controls among pa­tients with HF and stage 3–5 CKD.

Another recent meta-analysis of six RCTs of vari­ous classes of HF medications, which involved a total of 28,690 patients, showed that sacubitril/valsartan consis­tently reduced the occurrence of the composite kidney endpoint of sustained 40 percent, 50 percent or 57 per­cent decline in eGFR, ESRD, or renal death, irrespective of the specific eGFR decline threshold applied. [Circulation 2024;150:1858-1868]