Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan.
Sci Rep. 2021 Feb 25;11(1):4593. doi: 10.1038/s41598-021-84118-8.
Sacubitril/valsartan is a combined neprilysin inhibitor/angiotensin II receptor blocker designed for treatment of heart failure (HF). Nonetheless, its renal protective effect remained an issue of debate. This retrospective cohort study investigated the renal protective effect of sacubitril/valsartan in HF patients. HF patients on sacubitril/valsartan or valsartan for > 30 days were matched for gender, age, estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) to be enrolled into analysis. The follow-up period was 18 months. The outcomes included end eGFR, renal function decline defined as 20% reduction of eGFR, mortality, and HF-related hospitalization. Each group had 137 patients after matching. The mean age was 72.7 years and 65.7% were male. Mean eGFR was 70.9 mL/min/1.73 m and LVEF was 54.0% at baseline. Overall, the eGFR of sacubitril/valsartan groups was significantly higher than valsartan group at the end (P < 0.01). Subgroup analysis showed that the difference in eGFR was significant in subgroups with LVEF ≥ 40% or eGFR ≥ 60 mL/min/1.73 m. Multivariate Cox regression model showed that sacubitril/valsartan group had significantly reduced risk for renal function decline (hazard ratio: 0.5, 95% confidence interval: 0.3-0.9). Kaplan-Meier curve showed no difference in the risk for cardiovascular mortality, all-cause mortality or HF-related hospitalization. We showed renal protective effect of neprilysin inhibition in HF patients and specified that subgroups with LVEF ≥ 40% or eGFR ≥ 60 mL/min/1.73 m were sensitive to this effect, suggesting an optimal subgroup of this treatment.
沙库巴曲缬沙坦是一种新型的脑啡肽酶抑制剂/血管紧张素Ⅱ受体拮抗剂，用于心力衰竭（HF）的治疗。然而，其肾脏保护作用仍存在争议。本回顾性队列研究旨在探讨沙库巴曲缬沙坦对 HF 患者的肾脏保护作用。纳入 HF 患者，接受沙库巴曲缬沙坦或缬沙坦治疗>30 天，按性别、年龄、估算肾小球滤过率（eGFR）和左心室射血分数（LVEF）匹配后纳入分析。随访时间为 18 个月。主要终点包括终末期 eGFR、eGFR 下降 20%定义的肾功能下降、死亡率和 HF 相关住院率。匹配后每组各 137 例患者。患者平均年龄为 72.7 岁，65.7%为男性。平均 eGFR 为 70.9 mL/min/1.73 m2，LVEF 为 54.0%。总体而言，沙库巴曲缬沙坦组的 eGFR 终末期显著高于缬沙坦组（P<0.01）。亚组分析显示，LVEF≥40%或 eGFR≥60 mL/min/1.73 m2 的亚组中，eGFR 差异具有统计学意义。多变量 Cox 回归模型显示，沙库巴曲缬沙坦组肾功能下降的风险显著降低（风险比：0.5，95%置信区间：0.3-0.9）。Kaplan-Meier 曲线显示，心血管死亡率、全因死亡率或 HF 相关住院率无差异。我们证实了脑啡肽酶抑制剂对 HF 患者的肾脏保护作用，并指出 LVEF≥40%或 eGFR≥60 mL/min/1.73 m2 的亚组对此治疗效果敏感，提示该治疗的最佳亚组。
