Department of Nephrology, Peking University International Hospital, Beijing, PR. China.
Ren Fail. 2023 Dec;45(1):2222841. doi: 10.1080/0886022X.2023.2222841.
Data on angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril-valsartan (SV) in patients undergoing maintenance dialysis is scarce. Our study aimed to investigate the effect of SV on patients undergoing dialysis.
We retrospectively reviewed the data of end-stage kidney disease (ESRD) patients undergoing either peritoneal dialysis (PD) or hemodialysis (HD) in our center. A total of 51 patients receiving SV treatment were enrolled in the SV group. Another 51 age and sex-matched patients on dialysis without SV treatment were selected as the control group. All the patients were regularly followed up in the dialysis clinic. Their clinical, biochemical, and echocardiographic parameters were all recorded at baseline and during follow-up. The effect and safety of SV were further analyzed.
A total of 102 ESRD patients on dialysis (51 patients in the SV group and 51 patients in the control group) were finally enrolled. The median follow-up time was 349 days (interquartile range [IQR]: 217-535 days). The level of B-type natriuretic peptide (BNP) (median [IQR] before and after SV treatment: 596.35 pg/ml [190.6-1714.85] vs. 188.7 pg/ml [83.34-600.35], < 0.001) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) (median [IQR]: 6316.00 pg/ml [4552.00-28598.00] vs. 5074.00 pg/ml [2229.00-9851.00], = 0.022) were significantly decreased after treatment with SV. The variant rate of left ventricular ejection fraction (LVEF) was significantly higher in the SV group compared to the control group, especially in the PD subgroup. No significant difference was found in other echocardiographic parameters between SV and control group. Subgroup analysis of the PD group showed an increase in daily PD ultrafiltration (median [IQR]: 400 ml/d [200-500] vs. 500 ml/d [200-850], = 0.114) after SV treatment. Variant rate of overhydration (OH) measured by the body composition monitor (BCM) of the SV group were significantly different from the control group (median [IQR]: -13.13% [-42.85%-27.84%] vs. 0% [-17.95%-53.85%], = 0.049). The rate of hyperkalemia was slightly higher but without significant difference before and after the introduction of SV (19.6% vs. 27.5%, = 0.350). No event of hypotension and angioedema were observed.
SV might have a cardio-protective role in ESRD patients undergoing dialysis, especially in PD patients. Serum potassium should be monitored during the treatment.
关于血管紧张素受体-脑啡肽酶抑制剂（ARNI）沙库巴曲缬沙坦（SV）在维持性透析患者中的数据较为缺乏。本研究旨在探讨 SV 对透析患者的影响。
我们回顾性分析了我院行腹膜透析（PD）或血液透析（HD）的终末期肾病（ESRD）患者的数据。共纳入 51 例接受 SV 治疗的患者进入 SV 组，另选取 51 例年龄和性别相匹配且未接受 SV 治疗的透析患者作为对照组。所有患者均在透析门诊定期随访，记录其临床、生化和超声心动图参数。进一步分析 SV 的疗效和安全性。
共纳入 102 例透析的 ESRD 患者（SV 组 51 例，对照组 51 例）。中位随访时间为 349 天（四分位距：217-535 天）。SV 治疗前后 B 型利钠肽（BNP）水平（中位数[IQR]：596.35 pg/ml [190.6-1714.85] 比 188.7 pg/ml [83.34-600.35]， < 0.001）或 N 末端 B 型利钠肽前体（NT-proBNP）（中位数[IQR]：6316.00 pg/ml [4552.00-28598.00] 比 5074.00 pg/ml [2229.00-9851.00]， = 0.022）均显著下降。SV 组左心室射血分数（LVEF）的变异率明显高于对照组，尤其是 PD 亚组。SV 组与对照组之间的其他超声心动图参数无显著差异。PD 亚组的亚组分析显示，SV 治疗后每日 PD 超滤量（中位数[IQR]：400 ml/d [200-500] 比 500 ml/d [200-850]， = 0.114）增加。SV 组通过体成分监测仪（BCM）测量的水负荷变异率与对照组有显著差异（中位数[IQR]：-13.13% [-42.85%-27.84%] 比 0% [-17.95%-53.85%]， = 0.049）。SV 引入前后高钾血症的发生率虽略有升高但无显著差异（19.6% 比 27.5%， = 0.350）。未观察到低血压和血管性水肿事件。
SV 可能对透析的 ESRD 患者具有心脏保护作用，尤其对 PD 患者有益。治疗期间应监测血清钾。
