Efficacy and renal safety of sacubitril/valsartan in heart failure patients with chronic kidney disease: a prospective observational study
Amjad, Anum Zahid, Arva Sami, Nayab Wadud, Qaiser Omer, Mahda Awan, Muhammad Abbas Muhammad, Irshad
Amjad, Anum
Zahid, Arva
Sami, Nayab
Wadud, Qaiser
Omer, Mahda
Awan, Muhammad Abbas
Muhammad, Irshad
Affiliation
University Hospitals Birmingham NHS Foundation Trust; Shalamar Hospital; Shaikh Zayed Hospital; Khyber Teaching Hospital; Ahfad University for Women; Pakistan Ordnance Factories Hospital
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Publication date
2025-04-28
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Abstract
Background: Patients with heart failure (HF) and chronic kidney disease (CKD) often face therapeutic challenges, necessitating optimized treatment strategies to improve clinical outcomes. This study aims to evaluate the effectiveness of sacubitril/valsartan (Entresto) in improving clinical outcomes, reducing hospitalizations, and preserving renal function in HF patients with CKD, with a primary focus on changes in renal function (estimated glomerular filtration rate (eGFR)), and secondary outcomes, including heart performance (left ventricular ejection fraction (LVEF)) and hospitalization rates.
Methodology: This prospective observational study was conducted from January 2023 to December 2023. A total of 196 consecutively enrolled HF patients with CKD stages 2-4 were included and administered sacubitril/valsartan at FDA-recommended doses. Assessments of eGFR, hospitalization rates, LVEF, and adverse events were performed at three, six, and 12 months. Statistical analysis was conducted using SPSS version 25 (IBM Corp., Armonk, NY), and a p-value < 0.05 was considered significant.
Results: The mean eGFR improved significantly from 45.8 ± 12.4 mL/min/1.73 m² to 48.5 ± 11.5 mL/min/1.73 m² after 12 months (p = 0.032), representing a 5.90% increase. Hospitalizations decreased markedly from 210 to 48 events, with hospitalization rates dropping from 65.31% to 17.35%. LVEF improved significantly from 32.5 ± 6.7% to 41.5 ± 6.1% (27.69% increase). The New York Heart Association (NYHA) functional class also improved: class II patients increased from 43.88% to 63.27%, while class IV patients declined from 16.33% to 9.18%. Adverse events included hyperkalemia in 11.22%, symptomatic hypotension in 8.16%, and worsening renal function in 5.10% of patients; 7.14% of patients discontinued therapy due to side effects.
Conclusion: Sacubitril/valsartan demonstrated significant improvement in cardiac function, reduction in hospitalization rates, and preservation of renal function in HF patients with CKD, supporting its clinical utility in this population.
Citation
Amjad A, Zahid A, Sami N, Wadud Q, Omer M, Awan MA, Muhammad I. Efficacy and Renal Safety of Sacubitril/Valsartan in Heart Failure Patients With Chronic Kidney Disease: A Prospective Observational Study. Cureus. 2025 Apr 28;17(4):e83141. doi: 10.7759/cureus.83141.
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Article