PMID- 37449691
OWN - NLM
STAT- MEDLINE
DCOM- 20230717
LR  - 20230718
IS  - 0004-5772 (Print)
IS  - 0004-5772 (Linking)
VI  - 71
IP  - 7
DP  - 2023 Jul
TI  - Clinical Response and Safety of Angiotensin Receptor and Neprilysin Inhibitor 
      Combination in Advanced Chronic Kidney Disease and Heart Failure with Reduced 
      Ejection Fraction.
PG  - 11-12
LID - 10.59556/japi.71.0262 [doi]
AB  - BACKGROUND: Though the combination of an angiotensin receptor blocker (ARB) and a 
      neprilysin inhibitor (ARNi) has been shown to be useful in heart failure with 
      reduced ejection fraction (HFrEF), its use has mostly been restricted to chronic 
      kidney disease (CKD) patients with an estimated glomerular filtration rate (eGFR) 
      >30 mL/minute/1.73 m2 . We studied the role of ARNi in advanced CKD. MATERIALS 
      AND METHODS: Patients with HFrEF and advanced CKD with an eGFR of <30 mL/ 
      minute/1.73 m2 were given ARNi (sacubitril with valsartan) and prospectively 
      studied for changes in hospitalization rate for HF, clinical symptoms, levels of 
      N-terminal prohormone of brain natriuretic peptide (NT-proBNP), eGFR, and 
      potassium. RESULTS: Of 34 patients who received ARNi, five were excluded due to 
      hyperkalemia and three due to a decrease in eGFR >30% occurring within 1 
      month. The remaining 26 patients included 17 with diabetes mellitus (DM) and 23 
      with underlying coronary artery disease. A total of eight patients had stage 4 
      and 18 stage 5 CKDs, amongst which eight required hemodialysis. Following ARNi, 
      there was a significant decrease in the need for hospitalization for 
      breathlessness (2.04 +/- 1.03-0.23 +/- 0.51; p < 0,05), New York Heart Association 
      (NYHA) and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores (3.77 +/- 
      0.43-2.19 +/- 0.56 and 28.58 +/- 9.04-64.81 +/- 14.3, respectively, p < 0.001) and 
      NT-pro-BNP levels (24761 +/- 12157.51-20149.92 +/- 13555.269, p < 0.05) without 
      significant change in eGFR after 6 months. There were no significant differences 
      in the need for hospitalization, changes in NT proBNP levels and eGFR between 
      stages 4 and 5. CONCLUSION: Neprilysin inhibitor (ARNi) is effective and can be 
      used with care even in patients with CKD stages 4 and 5 having HFrEF with 
      monitoring of eGFR and potassium.
CI  - (c) Journal of the Association of Physicians of India 2011.
FAU - George, Jacob
AU  - George J
AD  - Professor and Head; Corresponding Author.
FAU - Gopal, Anjana
AU  - Gopal A
AD  - Senior Resident.
FAU - Gracious, Noble
AU  - Gracious N
AD  - Associate Professor, Department of Nephrology, Government Medical College, 
      Thiruvananthapuram, Kerala, India.
FAU - Kumar, Sajeev
AU  - Kumar S
AD  - Associate Professor, Department of Nephrology, Government Medical College, 
      Thiruvananthapuram, Kerala, India.
LA  - eng
PT  - Journal Article
PL  - India
TA  - J Assoc Physicians India
JT  - The Journal of the Association of Physicians of India
JID - 7505585
RN  - EC 3.4.24.11 (Neprilysin)
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Receptors, Angiotensin)
RN  - 0 (Tetrazoles)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Drug Combinations)
RN  - 0 (Antihypertensive Agents)
SB  - IM
MH  - Humans
MH  - *Heart Failure/drug therapy/diagnosis
MH  - Neprilysin/pharmacology
MH  - Angiotensin Receptor Antagonists/adverse effects
MH  - Stroke Volume
MH  - Receptors, Angiotensin
MH  - Tetrazoles/adverse effects
MH  - Angiotensin-Converting Enzyme Inhibitors
MH  - Drug Combinations
MH  - Antihypertensive Agents
MH  - *Renal Insufficiency, Chronic/complications
EDAT- 2023/07/14 13:08
MHDA- 2023/07/17 06:42
CRDT- 2023/07/14 07:39
PHST- 2023/07/17 06:42 [medline]
PHST- 2023/07/14 13:08 [pubmed]
PHST- 2023/07/14 07:39 [entrez]
AID - 10.59556/japi.71.0262 [doi]
PST - ppublish
SO  - J Assoc Physicians India. 2023 Jul;71(7):11-12. doi: 10.59556/japi.71.0262.