Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Eur J Heart Fail. 2022 May;24(5):794-803. doi: 10.1002/ejhf.2450. Epub 2022 Feb 15.
Diabetes is associated with a faster rate of renal function decline in patients with heart failure (HF). Sacubitril/valsartan attenuates the deterioration of renal function to a greater extent in patients with diabetes and HF with reduced ejection fraction compared with renin-angiotensin system inhibitors alone. We assessed whether the same may be true in HF with preserved ejection fraction (HFpEF).
In the PARAGON-HF trial in patients with HF and left ventricular ejection fraction of ≥45% (n = 4796), we characterized the effects of sacubitril/valsartan on changes in estimated glomerular filtration rate (eGFR) over a period of 192 weeks, and on the pre-specified renal composite outcome (eGFR reduction of ≥50%, end-stage renal disease, or death attributable to renal causes) in patients with (n = 2388) and without diabetes (n = 2408). The decline in eGFR was greater in patients with diabetes than in those without (-2.6 vs. -1.7 ml/min/1.73 m per year, p < 0.001), regardless of treatment assignment. Sacubitril/valsartan attenuated decline in eGFR similarly in patients with (-2.2 vs. -2.9 ml/min/1.73 m per year, p = 0.001) and without diabetes (-1.5 vs. -2.0 ml/min/1.73 m per year, p = 0.006) (p for difference in eGFR slopes = 0.40). Compared with valsartan, sacubitril/valsartan reduced the renal composite outcome similarly in patients without diabetes (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.19-0.91) and those with diabetes (HR 0.54, 95% CI 0.33-0.89; p = 0.59), as well as across a range of baseline glycated haemoglobin (p = 0.71).
Sacubitril/valsartan, compared with valsartan, attenuates the decline of eGFR and reduces clinically relevant kidney events similarly among patients with HFpEF with and without diabetes.
糖尿病与心力衰竭（HF）患者肾功能下降速度更快相关。与单独使用肾素-血管紧张素系统抑制剂相比，沙库巴曲缬沙坦在射血分数降低的糖尿病和 HF 患者中更能减轻肾功能恶化。我们评估其在射血分数保留的 HF（HFpEF）患者中是否同样如此。
在左心室射血分数≥45%（n=4796）的 PARAGON-HF 试验中，我们描述了沙库巴曲缬沙坦在 192 周期间对估算肾小球滤过率（eGFR）变化的影响，并描述了在有（n=2388）和无糖尿病（n=2408）的患者中对预先指定的肾脏复合结局（eGFR 下降≥50%、终末期肾病或由肾脏原因引起的死亡）的影响。与无糖尿病患者相比，糖尿病患者的 eGFR 下降更大（-2.6 比-1.7 ml/min/1.73 m 每年，p<0.001），无论治疗分配如何。沙库巴曲缬沙坦在有（-2.2 比-2.9 ml/min/1.73 m 每年，p=0.001）和无糖尿病患者中同样减弱 eGFR 的下降（-1.5 比-2.0 ml/min/1.73 m 每年，p=0.006）（p 用于比较 eGFR 斜率的差异=0.40）。与缬沙坦相比，沙库巴曲缬沙坦在无糖尿病患者（危险比[HR]0.42，95%置信区间[CI]0.19-0.91）和糖尿病患者（HR 0.54，95%CI 0.33-0.89；p=0.59）以及在一系列基线糖化血红蛋白（p=0.71）中同样降低了肾脏复合结局。
与缬沙坦相比，沙库巴曲缬沙坦在有和无糖尿病的 HFpEF 患者中同样减弱 eGFR 的下降并减少临床相关的肾脏事件。
