Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Cardiovasc Drugs Ther. 2024 Jun;38(3):505-515. doi: 10.1007/s10557-022-07421-0. Epub 2023 Jan 7.
Impaired renal function is frequently observed in patients with heart failure and reduced ejection fraction (HFrEF). The differential effect of sacubitril/valsartan and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEIs/ARBs) on the clinical and renal outcomes in patients with HFrEF and chronic kidney disease (CKD) remains unknown.
This study aimed to explore the differential effect of sacubitril/valsartan and ACEI/ARB on the clinical and renal outcomes as well as renal function over a 12-month follow-up period in HFrEF patients with and without CKD.
Patients with HfrEF (LVEF ≤35%) and NYHA class ≥II were enrolled from the Chang Gung Research Database between 2017 and 2020. Baseline characteristics were compared between patients prescribed sacubitril/valsartan and ACEI/ARB. After propensity score matching, the following clinical and renal outcomes were compared between the two groups in patients with and without CKD over a 12-month follow-up period: acute kidney injury (AKI), emergent dialysis/renal death, HF hospitalization, cardiovascular mortality, and all-cause mortality.
This study enrolled 3735 HFrEF patients with a mean left ventricular EF of 27.56 ± 5.86%, who had been prescribed sacubitril/valsartan (N = 1708) or ACEI/ARB (N = 2027). After propensity score matching, the clinical and renal outcomes did not differ between the sacubitril/valsartan and ACEI/ARB groups in patients without CKD. In patients with CKD, the ACEI/ARB group had a significantly higher incidence of all-cause mortality than the sacubitril/valsartan group (14.89% vs. 10.50%; hazard ratio 1.46; 95% confidence interval 1.06-2.00; p = 0.02), and the incidence of AKI, HF hospitalization, and CV mortality did not differ between the two groups.
Sacubitril/valsartan had a lower all-cause mortality compared to ACEI/ARB in symptomatic HFrEF patients with CKD. Further prospective randomized studies are warranted to confirm our findings.
心力衰竭伴射血分数降低（HFrEF）患者常伴有肾功能不全。沙库巴曲缬沙坦和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）对 HFrEF 合并慢性肾脏病（CKD）患者的临床和肾脏结局的影响尚不清楚。
本研究旨在探讨沙库巴曲缬沙坦和 ACEI/ARB 在 HFrEF 合并和不合并 CKD 患者中，12 个月随访期间对临床和肾脏结局以及肾功能的影响。
2017 年至 2020 年，从长庚研究数据库中招募 HFrEF 患者（LVEF≤35%，NYHA 分级≥Ⅱ级）。比较服用沙库巴曲缬沙坦和 ACEI/ARB 的患者的基线特征。采用倾向评分匹配后，比较 12 个月随访期间合并和不合并 CKD 的患者的以下临床和肾脏结局：急性肾损伤（AKI）、紧急透析/肾脏死亡、心力衰竭住院、心血管死亡率和全因死亡率。
本研究纳入 3735 例 HFrEF 患者，平均左心室射血分数为 27.56±5.86%，分别接受沙库巴曲缬沙坦（N=1708）或 ACEI/ARB（N=2027）治疗。采用倾向评分匹配后，在不合并 CKD 的患者中，沙库巴曲缬沙坦组和 ACEI/ARB 组的临床和肾脏结局无差异。在合并 CKD 的患者中，ACEI/ARB 组的全因死亡率显著高于沙库巴曲缬沙坦组（14.89%比 10.50%；风险比 1.46；95%置信区间 1.06-2.00；p=0.02），而两组的 AKI、心力衰竭住院和心血管死亡率无差异。
在合并 CKD 的有症状 HFrEF 患者中，与 ACEI/ARB 相比，沙库巴曲缬沙坦的全因死亡率更低。需要进一步进行前瞻性随机研究来证实我们的发现。
