Zhou Kai, Zhang Qiuyue, Dong Wen, Li Xin, Sun Yimiao, Zhang Ying
Xuzhou Medical University, Xuzhou, China.
The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Front Med (Lausanne). 2024 Sep 5;11:1421085. doi: 10.3389/fmed.2024.1421085. eCollection 2024.
The efficacy of the angiotensin receptor neprilysin inhibitor (ARNI) sacubitril/valsartan (SV) in patients with chronic kidney disease (CKD) has been established. Two meta-analyses have demonstrated its significant role in enhancing ventricular remodeling. However, the effectiveness and safety of its use in patients with end-stage renal disease (ESRD) remain unclear.
Up to October 2023, we searched the PubMed, Embase, and Web of Science databases for studies involving ESRD patients treated with ARNI. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Effect sizes were reported as mean differences (MD) with 95% confidence intervals (CIs). We included 10 studies, encompassing 649 patients. ARNI was associated with improvements in blood pressure and left ventricular (LV) function in ESRD patients, including systolic blood pressure (SBP) (MD -12.76 mmHg; 95% CI, -18.03 to -7.5 mmHg), diastolic blood pressure (DBP) (MD -6.41 mmHg; 95% CI, -8.10 to -4.72 mmHg), and left ventricular ejection fraction (LVEF) (MD, 4.61%; 95% CI, 1.78%-7.44%). Hemoglobin levels improved, but there were no significant statistical differences in other biomarkers for dialysis. Sacubitril/valsartan was generally well tolerated in ESRD patients. Improved indices of left ventricular function were noted at 6 months and were more pronounced at 12 months. A linear relationship between LVEF and left ventricular end-diastolic volume (LVEDV) was observed, as indicated by a high correlation coefficient (r-value).
ARNI effectively reduces blood pressure and enhances left ventricular function in dialysis patients, with early treatment associated with greater benefits. ARNI also demonstrates a favorable safety profile in this population. Further prospective studies are required to fully understand the long-term efficacy and safety of sacubitril/valsartan in dialysis patients.
血管紧张素受体脑啡肽酶抑制剂（ARNI）沙库巴曲缬沙坦（SV）在慢性肾脏病（CKD）患者中的疗效已得到证实。两项荟萃分析表明其在促进心室重构方面具有重要作用。然而，其在终末期肾病（ESRD）患者中使用的有效性和安全性仍不明确。
截至2023年10月，我们在PubMed、Embase和Web of Science数据库中检索了涉及接受ARNI治疗的ESRD患者的研究。使用纽卡斯尔-渥太华量表评估纳入研究的质量。效应量报告为均值差（MD）及95%置信区间（CI）。我们纳入了10项研究，共649例患者。ARNI与ESRD患者的血压和左心室（LV）功能改善相关，包括收缩压（SBP）（MD -12.76 mmHg；95% CI，-18.03至-7.5 mmHg）、舒张压（DBP）（MD -6.41 mmHg；95% CI，-8.10至-4.72 mmHg）和左心室射血分数（LVEF）（MD，4.61%；95% CI，1.78%-7.44%）。血红蛋白水平有所改善，但在其他透析生物标志物方面无显著统计学差异。沙库巴曲缬沙坦在ESRD患者中总体耐受性良好。左心室功能指标在6个月时有所改善，在12个月时更为明显。观察到LVEF与左心室舒张末期容积（LVEDV）之间存在线性关系，相关系数（r值）较高。
ARNI可有效降低透析患者的血压并增强左心室功能，早期治疗获益更大。ARNI在该人群中也显示出良好的安全性。需要进一步的前瞻性研究来全面了解沙库巴曲缬沙坦在透析患者中的长期疗效和安全性。
