Breaking barriers: Neprilysin inhibition in chronic cardiorenal syndrome

Over the last decade, neprilysin inhibition has been established as the cornerstone of therapy in heart failure (HF). Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) have a high prevalence of HF; the concomitant presence of HF and CKD or ESKD, conventionally termed chronic cardiorenal syndrome, is associated with a higher rate of adverse outcomes, including increased hospitalizations and mortality. The use of this novel class of medications in patients with advanced CKD or ESKD has been limited due to uncertainty about their efficacy and safety. Herein, we provide an overview of the available evidence on the use of neprilysin inhibition in HF and discuss how those concepts would apply to patients with concomitant CKD or ESKD.