Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World Experience
Background: data regarding the effectiveness and safety of sacubitril/valsartan in heart failure and reduced ejection fraction (HFrEF) patients with chronic kidney disease (CKD) are scarse. Objective: to evaluate the effectiveness and safety of sacubitril/valsartan in HFrEF and CKD in a real-world p...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/4/1334 |
| _version_ | 1797620236960137216 |
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| author | Sara C. Pereira Tiago Rodrigues Afonso Nunes-Ferreira João R. Agostinho Fausto J. Pinto Dulce Brito |
| author_facet | Sara C. Pereira Tiago Rodrigues Afonso Nunes-Ferreira João R. Agostinho Fausto J. Pinto Dulce Brito |
| author_sort | Sara C. Pereira |
| collection | DOAJ |
| description | Background: data regarding the effectiveness and safety of sacubitril/valsartan in heart failure and reduced ejection fraction (HFrEF) patients with chronic kidney disease (CKD) are scarse. Objective: to evaluate the effectiveness and safety of sacubitril/valsartan in HFrEF and CKD in a real-world population. Methods: we included consecutive ambulatory HFrEF patients that initiated sacubitril/valsartan between February 2017 and October 2020, stratified by CKD (KDIGO stage 5 excluded). Primary outcomes: the incidence rate per 100 patient-years and the annualized length of stay (LOS) of acute decompensated HF hospitalizations (HFH). Secondary outcomes: all-cause mortality, NYHA improvement, and titration of sacubitril/valsartan. Results: We included 179 patients, 77 with CKD, those being older (72 ± 10 vs. 65 ± 12 years, <i>p</i> < 0.001), had higher NT-proBNP (4623 ± 5266 vs. 1901 ± 1835 pg/mL, <i>p</i> < 0.001), and high anaemia incidence (<i>p</i> < 0.001). After 19 ± 11 months, a significant reduction in HFH adjusted incidence rate (57.5% decrease in CKD vs. 74.6%, <i>p</i> = 0.261) was observed, with 5 days there was a reduction in annualized LOS in both groups (<i>p</i> = 0.319). NYHA improved similarly in both groups (<i>p</i> = 0.670). CKD patients presented non-significant higher all-cause mortality (HR = 2.405, 95%CI: [0.841; 6.879], <i>p</i> = 0.102). Both groups had similar sacubitril/valsartan maximum dose achievement and drug withdrawal. Conclusion: sacubitril/valsartan was effective on reducing HFH and LOS without affecting all-cause mortality in a CKD real-world population. |
| first_indexed | 2024-03-11T08:39:15Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T08:39:15Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-fb402243c72c4fa5acd6a1024b7125e72023-11-16T21:18:06ZengMDPI AGJournal of Clinical Medicine2077-03832023-02-01124133410.3390/jcm12041334Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World ExperienceSara C. Pereira0Tiago Rodrigues1Afonso Nunes-Ferreira2João R. Agostinho3Fausto J. Pinto4Dulce Brito5Heart and Vessels Department, Cardiology Division, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., Av. Prof. Egas Moniz MB, 1649-028 Lisbon, PortugalHeart and Vessels Department, Cardiology Division, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., Av. Prof. Egas Moniz MB, 1649-028 Lisbon, PortugalHeart and Vessels Department, Cardiology Division, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., Av. Prof. Egas Moniz MB, 1649-028 Lisbon, PortugalHeart and Vessels Department, Cardiology Division, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., Av. Prof. Egas Moniz MB, 1649-028 Lisbon, PortugalHeart and Vessels Department, Cardiology Division, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., Av. Prof. Egas Moniz MB, 1649-028 Lisbon, PortugalHeart and Vessels Department, Cardiology Division, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., Av. Prof. Egas Moniz MB, 1649-028 Lisbon, PortugalBackground: data regarding the effectiveness and safety of sacubitril/valsartan in heart failure and reduced ejection fraction (HFrEF) patients with chronic kidney disease (CKD) are scarse. Objective: to evaluate the effectiveness and safety of sacubitril/valsartan in HFrEF and CKD in a real-world population. Methods: we included consecutive ambulatory HFrEF patients that initiated sacubitril/valsartan between February 2017 and October 2020, stratified by CKD (KDIGO stage 5 excluded). Primary outcomes: the incidence rate per 100 patient-years and the annualized length of stay (LOS) of acute decompensated HF hospitalizations (HFH). Secondary outcomes: all-cause mortality, NYHA improvement, and titration of sacubitril/valsartan. Results: We included 179 patients, 77 with CKD, those being older (72 ± 10 vs. 65 ± 12 years, <i>p</i> < 0.001), had higher NT-proBNP (4623 ± 5266 vs. 1901 ± 1835 pg/mL, <i>p</i> < 0.001), and high anaemia incidence (<i>p</i> < 0.001). After 19 ± 11 months, a significant reduction in HFH adjusted incidence rate (57.5% decrease in CKD vs. 74.6%, <i>p</i> = 0.261) was observed, with 5 days there was a reduction in annualized LOS in both groups (<i>p</i> = 0.319). NYHA improved similarly in both groups (<i>p</i> = 0.670). CKD patients presented non-significant higher all-cause mortality (HR = 2.405, 95%CI: [0.841; 6.879], <i>p</i> = 0.102). Both groups had similar sacubitril/valsartan maximum dose achievement and drug withdrawal. Conclusion: sacubitril/valsartan was effective on reducing HFH and LOS without affecting all-cause mortality in a CKD real-world population.https://www.mdpi.com/2077-0383/12/4/1334chronic kidney diseaseglomerular filtration rateheart failure with reduced ejection fractionangiotensin receptor neprilysin inhibitorsacubitril/valsartan |
| spellingShingle | Sara C. Pereira Tiago Rodrigues Afonso Nunes-Ferreira João R. Agostinho Fausto J. Pinto Dulce Brito Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World Experience Journal of Clinical Medicine chronic kidney disease glomerular filtration rate heart failure with reduced ejection fraction angiotensin receptor neprilysin inhibitor sacubitril/valsartan |
| title | Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World Experience |
| title_full | Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World Experience |
| title_fullStr | Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World Experience |
| title_full_unstemmed | Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World Experience |
| title_short | Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease—A Real-World Experience |
| title_sort | effectiveness and safety of sacubitril valsartan in patients with chronic kidney disease a real world experience |
| topic | chronic kidney disease glomerular filtration rate heart failure with reduced ejection fraction angiotensin receptor neprilysin inhibitor sacubitril/valsartan |
| url | https://www.mdpi.com/2077-0383/12/4/1334 |
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