The association of vascular access flow with sacubitril/valsartan and left ventricular ejection fraction in hemodialysis patients with heart failure with reduced ejection fraction

Background Sacubitril/valsartan improves heart function in maintenance hemodialysis (HD) patients with heart failure with a reduced ejection fraction of <40% (HFrEF). However, the effect of sacubitril/valsartan on vascular access flow (Qa) in this population is still unclear. Methods Hemodialysis patients with HFrEF were enrolled and divided into sacubitril/valsartan and non-sacubitril/valsartan treatment groups and received echocardiographic and Qa measurements at baseline and after 12 months. We compared the changes in Qa (△Qa) and echocardiographic parameters after 12 months. Correlations between △Qa and echocardiographic parameters were also examined. Multiple linear regression analysis was performed to predict △Qa. Results Thirty-three HD patients with HFrEF were enrolled. Sixteen patients received sacubitril/valsartan treatment. Their mean Qa significantly increased from 633.8 to 948.8 mL/min (P < .001). There was no significant change in Qa for the non-sacubitril/valsartan treatment group (from 637.7 to 621.8 mL/min; P = .436). The change in left ventricular ejection fraction (△LVEF) differed significantly between the sacubitril/valsartan and conventional treatment groups (13.63 ± 11.35% and 1.59 ± 6.99%, respectively; P = .001). The △Qa was significantly correlated with △LVEF (rs = 0.929; P < .001) and with the change in interventricular septum thickness in diastole (△IVSd, rs = −0.736; P = .001) in the sacubitril/valsartan group. The △Qa was predicted as −44.034 + 15.868 × △LVEF−25.072 × △IVSd + 145.964 × A (A = 1 for sacubitril/valsartan use and A = 0 for non-sacubitril/valsartan treatment) mL/min (R2 = 0.909). Conclusion In HD patients with HFrEF, treatment with sacubitril/valsartan is associated with improvement in LVEF and Qa over 12 months.