Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker
Objective: To assess 4 adverse renal outcomes in a heterogeneous cohort of patients with systolic heart failure (HF) who were prescribed sacubitril-valsartan vs angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB). Patients and Methods: The OptumLabs Database Warehouse, wh...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-04-01
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| Series: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542454820302083 |
| _version_ | 1819044816603840512 |
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| author | Nicholas Y. Tan, MD, MS Yihong Deng, PhD Xiaoxi Yao, PhD, MPH Lindsey R. Sangaralingham, MPH Nilay D. Shah, PhD Andrew D. Rule, MD John C. Burnett, Jr., MD Shannon M. Dunlay, MD, MS S. Jeson Sangaralingham, MS, PhD |
| author_facet | Nicholas Y. Tan, MD, MS Yihong Deng, PhD Xiaoxi Yao, PhD, MPH Lindsey R. Sangaralingham, MPH Nilay D. Shah, PhD Andrew D. Rule, MD John C. Burnett, Jr., MD Shannon M. Dunlay, MD, MS S. Jeson Sangaralingham, MS, PhD |
| author_sort | Nicholas Y. Tan, MD, MS |
| collection | DOAJ |
| description | Objective: To assess 4 adverse renal outcomes in a heterogeneous cohort of patients with systolic heart failure (HF) who were prescribed sacubitril-valsartan vs angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB). Patients and Methods: The OptumLabs Database Warehouse, which contains linked administrative claims and laboratory results, was used to identify patients with systolic HF who were prescribed sacubitril-valsartan or ACEi/ARB between July 1, 2015, and September 30, 2019. One-to-one propensity score matching and inverse probability of treatment weighting was used to balance baseline variables. Cox proportional hazards modeling was performed to compare renal outcomes in both medication groups, including 30% or more decline in estimated glomerular filtration rate (eGFR), doubling of serum creatinine, acute kidney injury (AKI), and kidney failure (eGFR < 15 mL/min per 1.73 m2, kidney transplant, or dialysis initiation). Results: A total of 4667 matched pairs receiving sacubitril-valsartan or ACEi/ARB were included; the mean follow-up period was 7.8±7.8 months. The mean age was 69.4±11 years; 35% were female, 19% black, and 15% Hispanic. The cumulative risk at 1 year was 6% for 30% or more decline in eGFR, 2% for doubling of serum creatinine, 3% for AKI, and 2% to 3% for kidney failure. Furthermore, no significant differences in risk were observed with sacubitril-valsartan compared with ACEi/ARB for a 30% or more decline in eGFR (hazard ratio [HR], 0.96; 95% CI, 0.79 to 1.10), doubling of serum creatinine (HR, 0.94; 95% CI, 0.69 to 1.27); AKI (HR, 0.80; 95% CI, 0.63 to 1.03), and kidney failure (HR 0.80; 95% CI, 0.59 to 1.08). Conclusion: Among patients with systolic HF, the risk of adverse renal outcomes was similar between patients prescribed sacubitril-valsartan and those prescribed ACEi/ARB. |
| first_indexed | 2024-12-21T10:18:41Z |
| format | Article |
| id | doaj.art-d269eef79b744dad85b0f14d40b5b2da |
| institution | Directory Open Access Journal |
| issn | 2542-4548 |
| language | English |
| last_indexed | 2024-12-21T10:18:41Z |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| spelling | doaj.art-d269eef79b744dad85b0f14d40b5b2da2022-12-21T19:07:32ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482021-04-0152286297Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor BlockerNicholas Y. Tan, MD, MS0Yihong Deng, PhD1Xiaoxi Yao, PhD, MPH2Lindsey R. Sangaralingham, MPH3Nilay D. Shah, PhD4Andrew D. Rule, MD5John C. Burnett, Jr., MD6Shannon M. Dunlay, MD, MS7S. Jeson Sangaralingham, MS, PhD8Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MNThe Robert and Patricia E. Kern Center for the Sciences of Healthcare Delivery, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; The Robert and Patricia E. Kern Center for the Sciences of Healthcare Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, MNThe Robert and Patricia E. Kern Center for the Sciences of Healthcare Delivery, Mayo Clinic, Rochester, MNThe Robert and Patricia E. Kern Center for the Sciences of Healthcare Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, MN; OptumLabs, Cambridge, MADivision of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Department of Health Services Research, Mayo Clinic, Rochester, MNDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Correspondence: Address to S. Jeson Sangaralingham, MS, PhD, Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.Objective: To assess 4 adverse renal outcomes in a heterogeneous cohort of patients with systolic heart failure (HF) who were prescribed sacubitril-valsartan vs angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB). Patients and Methods: The OptumLabs Database Warehouse, which contains linked administrative claims and laboratory results, was used to identify patients with systolic HF who were prescribed sacubitril-valsartan or ACEi/ARB between July 1, 2015, and September 30, 2019. One-to-one propensity score matching and inverse probability of treatment weighting was used to balance baseline variables. Cox proportional hazards modeling was performed to compare renal outcomes in both medication groups, including 30% or more decline in estimated glomerular filtration rate (eGFR), doubling of serum creatinine, acute kidney injury (AKI), and kidney failure (eGFR < 15 mL/min per 1.73 m2, kidney transplant, or dialysis initiation). Results: A total of 4667 matched pairs receiving sacubitril-valsartan or ACEi/ARB were included; the mean follow-up period was 7.8±7.8 months. The mean age was 69.4±11 years; 35% were female, 19% black, and 15% Hispanic. The cumulative risk at 1 year was 6% for 30% or more decline in eGFR, 2% for doubling of serum creatinine, 3% for AKI, and 2% to 3% for kidney failure. Furthermore, no significant differences in risk were observed with sacubitril-valsartan compared with ACEi/ARB for a 30% or more decline in eGFR (hazard ratio [HR], 0.96; 95% CI, 0.79 to 1.10), doubling of serum creatinine (HR, 0.94; 95% CI, 0.69 to 1.27); AKI (HR, 0.80; 95% CI, 0.63 to 1.03), and kidney failure (HR 0.80; 95% CI, 0.59 to 1.08). Conclusion: Among patients with systolic HF, the risk of adverse renal outcomes was similar between patients prescribed sacubitril-valsartan and those prescribed ACEi/ARB.http://www.sciencedirect.com/science/article/pii/S2542454820302083 |
| spellingShingle | Nicholas Y. Tan, MD, MS Yihong Deng, PhD Xiaoxi Yao, PhD, MPH Lindsey R. Sangaralingham, MPH Nilay D. Shah, PhD Andrew D. Rule, MD John C. Burnett, Jr., MD Shannon M. Dunlay, MD, MS S. Jeson Sangaralingham, MS, PhD Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| title | Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker |
| title_full | Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker |
| title_fullStr | Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker |
| title_full_unstemmed | Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker |
| title_short | Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker |
| title_sort | renal outcomes in patients with systolic heart failure treated with sacubitril valsartan or angiotensin converting enzyme inhibitor angiotensin receptor blocker |
| url | http://www.sciencedirect.com/science/article/pii/S2542454820302083 |
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