Objective To investigate the clinical efficacy of sacubitril/valsartan in maintenance hemodialysis (MHD) patients with heart failure. Methods A retrospective cohort study was performed in the MHD patients with heart failure treated in Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January 1, 2020, to July 31, 2021. Patients who took the medicine for more than 3 months were included in this study. Clinical data, demographic characteristics, laboratory indicators, echocardiography, adverse response of the treatment, and endpoint events were recorded. Results A total of 54 patients were enrolled and followed up for 3 months. Sacubitril/valsartan treatment significantly reduced NT-proBNP (15213.15±12110.44 vs. 7823.21±7457.71ng/L, t=7.053, P＜0.001), interventricular septal thickness dimension (IVSTd; 10.24±1.81 vs. 9.79±1.96mm, t=2.557, P=0.013), left ventricular posterior wall thickness dimension (LVPWTd; 10.04±1.69 vs. 9.44±1.61mm, t=2.728, P=0.009), left ventricular mass index (LVMI; 126.30±42.79 vs. 113.81±34.74g/m2, t=3.059, P=0.003), systolic blood pressure (SBP; 160.46±16.43 vs. 139.19±15.21mmHg, t=12.381, P＜0.001) and diastolic blood pressure (DBP; 79.57±11.97 vs. 69.67±10.43mmHg, t=7.070, P＜0.001). Meanwhile, left ventricular ejection fraction (LVEF) increased after three months of the treatment (55.76±8.30% to 60.02±6.18%, t=-4.323, P＜0.001). There were no significant differences in dry body mass (t=0.465, P=0.644), body mass gain (t=0.350, P=0.728), ultrafiltration (t=-0.019, P=0.985), parathyroid hormone (PTH, t=-1.660, P=0.103), serum creatinine (Scr, t=-1.452, P=0.152), Kalium (K, t=-1.806, P=0.077), Natrium (Na, t=0.400, P=0.690), Calcium (Ca, t=-1.376, P=0.175), Phosphorus (P, t=-0.193, P=0.848), hemoglobin (HGB, t=-0.710, P=0.481) and albumin (ALB, t=-1.823, P=0.074) before and after the treatment. Conclusion Sacubitril/valsartan could effectively and safely relieve the clinical symptom of heart failure, improve cardiac function indicators, reduce left ventricular hypertrophy, reverse left ventricular remodeling, and lower blood pressure in MHD patients with heart failure.
[1]Go A S, Chertow G M, Fan D, et al.Chronic kidney disease and the risks of death,cardiovascular events,and hospitalization[J].New England Journal of Medicine, 2004, 41(13):177-177
[2]Kim M S, Lee J H, Kim E J, et al.Korean Guidelines for Diagnosis and Management of Chronic Heart Failure[J].Korean Circulation Journal, 2017, 47(5):555-643
[3]Yuhui, Zhang, Jian, et al.Contemporary Epidemiology,Management,and Outcomes of Patients Hospitalized for Heart Failure in China: Results From the China Heart Failure (China-HF) Registry[J].Journal of Cardiac Failure, 2017, 23(12):868-875
[4]Ollendorf D A, Sandhu A T, Pearson S D.Sacubitril-Valsartan for the Treatment of Heart Failure: Effectiveness and Value[J].Jama Intern Med, 2016, 176(2):249-250
[5]Mcmurray J J, Packer M, Desai A S, et al.Angiotensin-neprilysin inhibition versus enalapril in heart failure[J].New England Journal of Medicine, 2014, 371(11):993-1004
[6] Rangaswami J, Bhalla V, Blair J E A, et al.Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association[J].Circulation, 2019, 139(16):840-878
[7] 中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志, 2018, 46(10):760-789
[8] Marwick T H, Gillebert T C, Aurigemma G, et al.Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)[J].Journal of the American Society of Echocardiography,, 2015, 16(6):577-605
[9] Stevenson PH.Calculation of the body-surface area of Chinese[J].Chin J Physiol, Report Series, 1928, 1(1):13-24
[10]G Romero-Gonzalez, Ravassa S, O Gonzalez, et al.Burden and challenges of heart failure in patients with chronic kidney diseaseA call to action[J].Nefrología (English Edition), 2020, 40(3):223-236
[11]None.Chapter 8: Cardiovascular Disease in Patients With ESRD[J].American Journal of Kidney Diseases, 2018, 71(3):S417-S432
[12] Hou F, Jiang J, Chen J, et al.China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis[J].BMC Nephrology, 2012, 13(94):1-9
[13]中国医疗保健国际交流促进会高血压分会、中国高血压联盟、中国心血管健康联盟、中国医师协会心血管内科医师分会. 沙库巴曲缬沙坦在高血压患者临床应用的中国专家建议[J].中华高血压杂志, 2021, 29(02):108-114
[14]Chang H Y, Feng A N, Fong M C, et al.Sacubitril/valsartan in heart failure with reduced ejection fraction patients: Real world experience on advanced chronic kidney disease, hypotension, and dose escalation[J].Journal of Cardiology, 2019, 74(4):372-380
[15]Porcile R, Infantas M T Z, Levín R, et al.Remodelación inversa del miocardio y reducción de marcadores inflamatorios en pacientes con insuficiencia cardíaca tratada con sacubitrilovalsartán[J].Insuficiencia cardíaca, 2018, 13(3):104-109
[16]Quiroga B, de Santos A, Sapiencia D, et al.Experiencia clínica con sacubitrilovalsartán en pacientes con insuficiencia renal: la visión del nefrólogo[J].nefrologia, 2019, 39(6):646-652
[17]Heyse A, Manhaeghe L, Mahieu E, et al.Sacubitrilvalsartan in heart failure and end‐stage renal insufficiency[J].ESC Heart Failure, 2019, 6(6):1331-1333
[18]Milton Packer，John J V McMurray，et al.. Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure[J].Circulation, 2015, 131(1):54-61
[19]Rrth R, Jhund P S, Yilmaz M B, et al.Comparison of BNP and NT-proBNP in Patients With Heart Failure and Reduced Ejection Fraction[J].Circulation. Heart failure, 2020, 13(2):6541-6551
[20]Januzzi J L, Prescott M F, Butler J, et al.Association of Change in N-Terminal Pro-B-Type Natriuretic Peptide Following Initiation of Sacubitril-Valsartan Treatment With Cardiac Structure and Function in Patients With Heart Failure With Reduced Ejection Fraction[J].JAMA, 2019, 322(11):1085-1095
[21]Desai A S, Solomon S D, Shah A M, et al.Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial[J].JAMA The Journal of the American Medical Association, 2019, 322(11):1077-1084
[22]Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group.KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney?Disease[J].Kidney Int, 2021, 99(3s):s1-s87
[23]Kario K, Tamaki Y, Okino N, et al.LCZ696,a First‐in‐Class Angiotensin Receptor‐Neprilysin Inhibitor: The First Clinical Experience in Patients With Severe Hypertension[J].Journal of Clinical Hypertension, 2016, 18(4):308-314
