Pereira Sara C, Rodrigues Tiago, Nunes-Ferreira Afonso, Agostinho João R, Pinto Fausto J, Brito Dulce
Heart and Vessels Department, Cardiology Division, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., Av. Prof. Egas Moniz MB, 1649-028 Lisbon, Portugal.
Cardiovascular Centre of the University of Lisbon (CCUL), CAML, Lisbon School of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
J Clin Med. 2023 Feb 7;12(4):1334. doi: 10.3390/jcm12041334.
data regarding the effectiveness and safety of sacubitril/valsartan in heart failure and reduced ejection fraction (HFrEF) patients with chronic kidney disease (CKD) are scarse.
to evaluate the effectiveness and safety of sacubitril/valsartan in HFrEF and CKD in a real-world population.
we included consecutive ambulatory HFrEF patients that initiated sacubitril/valsartan between February 2017 and October 2020, stratified by CKD (KDIGO stage 5 excluded).
the incidence rate per 100 patient-years and the annualized length of stay (LOS) of acute decompensated HF hospitalizations (HFH).
all-cause mortality, NYHA improvement, and titration of sacubitril/valsartan.
We included 179 patients, 77 with CKD, those being older (72 ± 10 vs. 65 ± 12 years, < 0.001), had higher NT-proBNP (4623 ± 5266 vs. 1901 ± 1835 pg/mL, < 0.001), and high anaemia incidence ( < 0.001). After 19 ± 11 months, a significant reduction in HFH adjusted incidence rate (57.5% decrease in CKD vs. 74.6%, = 0.261) was observed, with 5 days there was a reduction in annualized LOS in both groups ( = 0.319). NYHA improved similarly in both groups ( = 0.670). CKD patients presented non-significant higher all-cause mortality (HR = 2.405, 95%CI: [0.841; 6.879], = 0.102). Both groups had similar sacubitril/valsartan maximum dose achievement and drug withdrawal.
sacubitril/valsartan was effective on reducing HFH and LOS without affecting all-cause mortality in a CKD real-world population.
关于沙库巴曲缬沙坦在慢性肾脏病（CKD）合并射血分数降低的心力衰竭（HFrEF）患者中的有效性和安全性的数据较少。
评估沙库巴曲缬沙坦在真实世界人群中治疗HFrEF和CKD的有效性和安全性。
我们纳入了2017年2月至2020年10月期间开始使用沙库巴曲缬沙坦的连续性门诊HFrEF患者，并根据CKD进行分层（排除KDIGO 5期）。
每100患者年急性失代偿性心力衰竭住院（HFH）的发生率以及年化住院时间（LOS）。
全因死亡率、纽约心脏协会（NYHA）心功能改善情况以及沙库巴曲缬沙坦的滴定情况。
我们纳入了179例患者，其中77例患有CKD，这些患者年龄更大（72±10岁 vs. 65±12岁，P<0.001），N末端脑钠肽前体（NT-proBNP）更高（4623±5266 vs. 1901±1835 pg/mL，P<0.001），贫血发生率也更高（P<0.001）。19±11个月后，观察到HFH调整后发生率显著降低（CKD组降低57.5%，非CKD组降低74.6%，P=0.261），两组年化LOS均减少了5天（P=0.319）。两组NYHA改善情况相似（P=0.670）。CKD患者全因死亡率虽有升高但无统计学意义（风险比[HR]=2.405，95%置信区间[CI]：[0.841；6.879]，P=0.102）。两组沙库巴曲缬沙坦最大剂量达标率和停药情况相似。
在CKD真实世界人群中，沙库巴曲缬沙坦在降低HFH和LOS方面有效，且不影响全因死亡率。
