Successful kidney transplantation after significant improvement of left ventricular function with guideline-directed medical therapy including angiotensin receptor-neprilysin inhibitor and beta blocker in a hemodialysis patient: a case report

Background Although angiotensin receptor-neprilysin inhibitor (ARNI; sacubitril/valsartan) is a well-established treatment for heart failure with reduced ejection fraction (HFrEF), evidence of its efficacy in hemodialysis (HD) patients remains limited. Case presentation We present the case of a 60-year-old woman who underwent HD for 8 years for diabetic nephropathy; 1.5 years prior to heart failure treatment, her echocardiogram revealed a severely reduced left ventricular ejection fraction (LVEF) and left ventricular end-diastolic and end-systolic volume indices (LVEDVI and LVESVI, respectively) of 24%, 91.1, and 69.2, respectively. The patient was considered ineligible for kidney transplantation because of severe left ventricular dysfunction. After referral to our department, heart failure therapy with ARNI and carvedilol were initiated and titrated to sacubitril/valsartan 100 mg/day and carvedilol 20 mg/day. LVEF gradually improved, reaching 56% after 9 months, with improvements in LVESVI (53.5) and LVEDVI (23.5), ultimately leading to successful kidney transplantation. Conclusions This case highlights a rare and successful reversal of severe HFrEF in a HD patient through the safe and effective use of ARNI, enabling eligibility for kidney transplantation. This emphasizes the importance of guideline-directed medical therapy for HD patients with heart failure.