PMID- 35709921 OWN - NLM STAT- MEDLINE DCOM- 20220712 LR - 20220712 IS - 1879-0712 (Electronic) IS - 0014-2999 (Linking) VI - 928 DP - 2022 Aug 5 TI - Effect of Sacubitril/Valsartan on renal function in patients with chronic kidney disease and heart failure with preserved ejection fraction: A real-world 12-week study. PG - 175053 LID - S0014-2999(22)00314-4 [pii] LID - 10.1016/j.ejphar.2022.175053 [doi] AB - Patients with chronic kidney disease (CKD) are often complicated with heart failure with preserved ejection fraction (HFpEF). However, several drugs, including angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB), have not shown apparent benefits in terms of morbidity and mortality of HFpEF. PARAMOUNT and other studies have shown the potential benefits of Sacubitril/Valsartan on patients with HFpEF, but its effects on renal function and the effect of low-dose Sacubitril/Valsartan in actual clinical conditions have not been thoroughly evaluated. In our longitudinal and observational research, 353 patients were followed up for 12 weeks. We evaluated renal function [urinary protein, serum creatinine and estimated glomerular filtration rate (eGFR)] and cardiac function [NT-proBNP (brain natriuretic peptide), New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), left atrial width and left ventricular end-diastolic width] at baseline and during follow-up. Worsening renal function (WRF) was defined as an increased serum creatinine>/=26.5umol/L or decreased eGFR>/=20%. The decline of eGFR in the Sacubitril/Valsartan group was slower than that in the control group (p = 0.021). The outcome of proteinuria in the ACEI/ARB group was significantly better than that in the Sacubitril/Valsartan group (p = 0.001). In terms of echocardiogram, the average left atrial width in Sacubitril/Valsartan group decreased by 1.38 +/- 3.02 mm, which was significantly lower than that in the ACEI/ARB group (p = 0.02). The increase of urine protein class in the ACEI/ARB group increased the risk of WRF with statistical significance (OR = 2.36, 95%CI 1.01-5.49, p = 0.047), but no statistical significance was found in all the patients or Sacubitril/Valsartan group. In conclusion, Sacubitril/Valsartan could more effectively slow down renal function decline and reverse myocardial remodeling in patients with CKD and HFpEF than ACEI/ARB, even at low doses, though its protective effect on urinary protein is not as good as that of ACEI/ARB. CI - Copyright (c) 2022 Elsevier B.V. All rights reserved. FAU - Jia, Ruoyu AU - Jia R AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Zhang, Xuejie AU - Zhang X AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Xu, Yizhou AU - Xu Y AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Zheng, Zhifang AU - Zheng Z AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Jiang, Luhua AU - Jiang L AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Zhang, Xin AU - Zhang X AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China; Institute of Nephrology, Xuzhou Medical University, Xuzhou, 221002, China. FAU - Sun, Chen AU - Sun C AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Wu, Xin AU - Wu X AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Li, Shulin AU - Li S AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Raj, Ashok AU - Raj A AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China; Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. FAU - Sun, Dong AU - Sun D AD - Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China; Institute of Nephrology, Xuzhou Medical University, Xuzhou, 221002, China. Electronic address: sundongxz@126.com. LA - eng PT - Journal Article DEP - 20220614 PL - Netherlands TA - Eur J Pharmacol JT - European journal of pharmacology JID - 1254354 RN - 0 (Aminobutyrates) RN - 0 (Angiotensin Receptor Antagonists) RN - 0 (Angiotensin-Converting Enzyme Inhibitors) RN - 0 (Biphenyl Compounds) RN - 0 (Drug Combinations) RN - 0 (Tetrazoles) RN - 17ERJ0MKGI (sacubitril) RN - 80M03YXJ7I (Valsartan) RN - AYI8EX34EU (Creatinine) SB - IM MH - Aminobutyrates/adverse effects MH - Angiotensin Receptor Antagonists/adverse effects MH - Angiotensin-Converting Enzyme Inhibitors/adverse effects MH - Biphenyl Compounds/pharmacology MH - Creatinine MH - Drug Combinations MH - *Heart Failure MH - Humans MH - Kidney/physiology MH - *Renal Insufficiency, Chronic/complications/drug therapy MH - Stroke Volume MH - Tetrazoles/adverse effects MH - Valsartan/pharmacology/therapeutic use MH - Ventricular Function, Left OTO - NOTNLM OT - ARNI OT - CKD OT - HFpEF OT - Proteinuria OT - RAAS OT - Sacubitril/Valsartan OT - eGFR EDAT- 2022/06/17 06:00 MHDA- 2022/07/14 06:00 CRDT- 2022/06/16 19:24 PHST- 2022/03/16 00:00 [received] PHST- 2022/05/19 00:00 [revised] PHST- 2022/05/19 00:00 [accepted] PHST- 2022/06/17 06:00 [pubmed] PHST- 2022/07/14 06:00 [medline] PHST- 2022/06/16 19:24 [entrez] AID - S0014-2999(22)00314-4 [pii] AID - 10.1016/j.ejphar.2022.175053 [doi] PST - ppublish SO - Eur J Pharmacol. 2022 Aug 5;928:175053. doi: 10.1016/j.ejphar.2022.175053. Epub 2022 Jun 14.