Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
Clin Pharmacol Ther. 2024 Aug;116(2):471-477. doi: 10.1002/cpt.3315. Epub 2024 Jun 16.
Sacubitril/valsartan (Entresto) has proven therapeutic effects in heart failure (HF) patients, but its impact on those with advanced chronic kidney disease (CKD) remains unclear, particularly in HF patients with coexisting end-stage renal disease (ESRD). This study aims to assess the long-term survival of patients with heart failure with reduced ejection fraction (HFrEF) and coexisting ESRD treated with sacubitril/valsartan. A retrospective cohort study included 2,860 HFrEF and ESRD patients between January 2008 and December 2020. After propensity score matching, data from a sacubitril/valsartan group (n = 61) and a candesartan or valsartan group (n = 117) were analyzed. Patients on sacubitril/valsartan for at least 9 months had significantly lower 5-year all-cause mortality (39.3%) compared with the non-sacubitril/valsartan group (54.7%) (HR 0.46; 95% CI, 0.25-0.82; P = 0.0094). Left ventricular ejection fraction (LVEF) improvement after 3 years in the sacubitril/valsartan group (14.51 ±18.98) was significantly greater than the non-sacubitril/valsartan group (6.91 ±18.44) (P = 0.0408). Average hospitalizations in sacubitril/valsartan and non-sacubitril/valsartan groups were 1.39 and 0.97, respectively (incidence rate ratio, 1.59; 95% CI, 0.90-2.82; P = 0.1106). Sacubitril/valsartan treatment demonstrated significantly lower 5-year mortality rates and greater LVEF improvement in HFrEF patients with coexisting ESRD compared with candesartan or valsartan. These findings suggest that sacubitril/valsartan is a beneficial treatment option for this patient population.
沙库巴曲缬沙坦（Entresto）已被证明对心力衰竭（HF）患者具有治疗作用，但它对合并终末期肾病（ESRD）的慢性肾脏病（CKD）患者的影响尚不清楚，特别是对合并 ESRD 的 HF 患者。本研究旨在评估射血分数降低的心力衰竭（HFrEF）合并并存 ESRD 患者使用沙库巴曲缬沙坦的长期生存率。一项回顾性队列研究纳入了 2008 年 1 月至 2020 年 12 月期间的 2860 例 HFrEF 和 ESRD 患者。经过倾向评分匹配后，对沙库巴曲缬沙坦组（n=61）和坎地沙坦或缬沙坦组（n=117）的数据进行了分析。至少使用沙库巴曲缬沙坦 9 个月的患者 5 年全因死亡率（39.3%）明显低于非沙库巴曲缬沙坦组（54.7%）（HR 0.46；95%CI，0.25-0.82；P=0.0094）。沙库巴曲缬沙坦组 3 年后左心室射血分数（LVEF）改善（14.51±18.98）明显大于非沙库巴曲缬沙坦组（6.91±18.44）（P=0.0408）。沙库巴曲缬沙坦组和非沙库巴曲缬沙坦组的平均住院次数分别为 1.39 和 0.97（发病率比，1.59；95%CI，0.90-2.82；P=0.1106）。与坎地沙坦或缬沙坦相比，沙库巴曲缬沙坦治疗可显著降低合并 ESRD 的 HFrEF 患者的 5 年死亡率和提高 LVEF。这些发现表明，沙库巴曲缬沙坦是该患者人群的有益治疗选择。
