Key result
Sacubitril/valsartan significantly reduced systolic blood pressure by 12.76 mmHg and improved left ventricular ejection fraction by 4.61% in patients with end-stage renal disease on dialysis.
Why the study?
Although the efficacy of sacubitril/valsartan in chronic kidney disease is established, its effectiveness and safety in patients with end-stage renal disease remained unclear.
Does sacubitril/valsartan improve blood pressure and left ventricular function in adult patients with end-stage renal disease on dialysis?
Systematic Review (n=649)
Does sacubitril/valsartan improve blood pressure and left ventricular function in adult patients with end-stage renal disease on dialysis?
Mean Difference: -12.76 (95% CI -18.03–-7.5)
Sacubitril/valsartan effectively reduces blood pressure and improves left ventricular function in dialysis patients, suggesting a potential role for ARNI in managing cardiovascular risk in end-stage renal disease.
Background: The efficacy of the angiotensin receptor neprilysin inhibitor (ARNI) sacubitril/valsartan (SV) in patients with chronic kidney disease (CKD) has been established. Two meta-analyses have demonstrated its significant role in enhancing ventricular remodeling. However, the effectiveness and safety of its use in patients with end-stage renal disease (ESRD) remain unclear. Methods and results: Up to October 2023, we searched the PubMed, Embase, and Web of Science databases for studies involving ESRD patients treated with ARNI. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Effect sizes were reported as mean differences (MD) with 95% confidence intervals (CIs). We included 10 studies, encompassing 649 patients. ARNI was associated with improvements in blood pressure and left ventricular (LV) function in ESRD patients, including systolic blood pressure (SBP) (MD -12.76 mmHg; 95% CI, -18.03 to -7.5 mmHg), diastolic blood pressure (DBP) (MD -6.41 mmHg; 95% CI, -8.10 to -4.72 mmHg), and left ventricular ejection fraction (LVEF) (MD, 4.61%; 95% CI, 1.78%-7.44%). Hemoglobin levels improved, but there were no significant statistical differences in other biomarkers for dialysis. Sacubitril/valsartan was generally well tolerated in ESRD patients. Improved indices of left ventricular function were noted at 6 months and were more pronounced at 12 months. A linear relationship between LVEF and left ventricular end-diastolic volume (LVEDV) was observed, as indicated by a high correlation coefficient (r-value). Conclusion: ARNI effectively reduces blood pressure and enhances left ventricular function in dialysis patients, with early treatment associated with greater benefits. ARNI also demonstrates a favorable safety profile in this population. Further prospective studies are required to fully understand the long-term efficacy and safety of sacubitril/valsartan in dialysis patients.
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Zhou et al. (2024) conducted a systematic review in End-stage renal disease (ESRD) (n=649). Sacubitril/valsartan (ARNI) vs. Self-comparison or ACEI/ARB was evaluated on Systolic blood pressure (SBP) (MD -12.76 mmHg, 95% CI -18.03 to -7.50). Sacubitril/valsartan significantly reduced systolic blood pressure by 12.76 mmHg and improved left ventricular ejection fraction by 4.61% in patients with end-stage renal disease on dialysis.
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