Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy.
Curr Med Res Opin. 2021 Jan;37(1):9-12. doi: 10.1080/03007995.2020.1853509. Epub 2020 Dec 13.
The worsening of renal function after the start of valsartan therapy is relatively common in clinical practice. However, few data are available on the incidence of worsening renal function after the beginning of therapy with sacubitril/valsartan.
We retrospectively enrolled 202 outpatients with HFrEF that started therapy with sacubitril/valsartan to evaluate the prevalence of worsening renal function and its clinical significance.
At 1 month, a worsening renal function (defined as > 20% decrease in eGFR occurring after 1 month of ARNi therapy) was found in 68 patients (33%), however after a mean follow-up of 650 ± 80 days, Kaplan-Meier analysis showed no significant in terms of HF-related deaths, HF-related hospitalizations, and the need for renal replacement therapy (25.2 vs. 23.6%; = .812). In addition, the renal function recovered in patients with early WRF at 3 months (62 + 9.3 ml/min/1.73 m vs. 63 ± 13.8 ml/min/1.73 m; < .05), with an improvement in estimated glomerular filtration rate at 1 year compared with baseline value (62 ± 9.3 ml/min/1.73 m vs. 69 ± 8.6 ml/min/1.73 m; < .01).
WRF occurs in nearly 30% of HFrEF patients without impacting clinical outcomes; HF specialists should be aware of these changes to avoid unnecessary discontinuation of sacubitril/valsartan therapy.
缬沙坦治疗开始后肾功能恶化在临床实践中较为常见。然而，关于起始沙库巴曲缬沙坦治疗后肾功能恶化的发生率的数据较少。
我们回顾性纳入了 202 例开始接受沙库巴曲缬沙坦治疗的射血分数降低的心力衰竭（HFrEF）门诊患者，以评估肾功能恶化的发生率及其临床意义。
1 个月时，68 例（33%）患者出现肾功能恶化（定义为 ARNi 治疗 1 个月后 eGFR 下降>20%）。然而，在平均 650±80 天的随访后，Kaplan-Meier 分析显示，在心力衰竭相关死亡、心力衰竭相关住院和肾脏替代治疗的需求方面无显著差异（25.2%比 23.6%； = .812）。此外，在早期发生 WRF 的患者中，肾功能在 3 个月时恢复（62 + 9.3 ml/min/1.73 m 比 63 ± 13.8 ml/min/1.73 m； < .05），与基线值相比，1 年时估算肾小球滤过率改善（62 ± 9.3 ml/min/1.73 m 比 69 ± 8.6 ml/min/1.73 m； < .01）。
近 30%的 HFrEF 患者发生 WRF，但不影响临床结局；心力衰竭专家应注意这些变化，避免不必要地停用沙库巴曲缬沙坦治疗。
