Clinical Effectiveness of Sacubitril/Valsartan in Heart Failure Patients With Coexisting Chronic Kidney Disease.

Introduction Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, posing significant management challenges due to overlapping pathophysiology and therapeutic limitations, particularly in patients with impaired renal function. The objective of this study is to assess how sacubitril/valsartan improves functional status, left ventricular ejection fraction (LVEF), and hospitalization rates in clinical settings while also tracking the trajectories of renal function in patients suffering from heart failure with reduced ejection fraction (HFrEF) and coexisting CKD. Methodology This prospective observational study was conducted from January 2023 to December 2024 at the Department of Cardiology, Gujranwala Medical College (GMC) (constituent college of the University of Health Sciences {UHS}, Lahore), Gujranwala Teaching Hospital, Pakistan. A total of 194 adult HFrEF patients with CKD (estimated glomerular filtration rate {eGFR}: 15-60 mL/minute/1.73 m²) who were initiated on sacubitril/valsartan were enrolled. Patients were followed for 24 months, with periodic assessments of New York Heart Association (NYHA) functional class, LVEF, estimated glomerular filtration rate (eGFR), and heart failure-related hospitalizations. Results By 24 months, 102 patients (52.6%) had improved to NYHA Classes I-II from 66 (34.0%) at baseline, while only 26 (13.4%) remained in Classes III-IV (p < 0.05). The mean LVEF improved from 32.5% ± 6.7% to 35.2% ± 6.3% (p < 0.05). Renal function showed a modest but statistically significant decline, with mean eGFR decreasing from 39.2 ± 9.6 to 37.4 ± 10.2 mL/minute/1.73 m² (p < 0.05). A total of 68 patients (35.1%) required one or more HF-related hospitalizations during follow-up, reflecting a gradual rise in admissions (p < 0.05). Conclusion In this cohort of HFrEF patients with CKD, sacubitril/valsartan was associated with improvements in functional status and cardiac performance. However, a modest decline in renal function and a progressive increase in hospitalizations were observed over time, underscoring the need for individualized therapy, careful diuretic titration, and close renal monitoring during long-term angiotensin receptor-neprilysin inhibitor (ARNI) use.