Dose reduction and discontinuation of sacubitril/valsartan over time in patients undergoing maintenance hemodialysis

Objective This study aims to evaluate the therapeutic effects and dose adjustment patterns of sacubitril/valsartan (SV) over time in patients undergoing maintenance hemodialysis (HD). Methods The clinical data of end-stage renal disease patients receiving maintenance HD at our center were retrospectively reviewed. A total of 151 patients treated with SV were included. All patients were followed up regularly in the dialysis outpatient clinic. The clinical characteristics, biochemical parameters, and echocardiographic measurements were collected at baseline and during follow-up. The efficacy, safety, and dose adjustment patterns of SV therapy were analyzed. Results A six-month observation period was selected for analysis to ensure adequate follow-up while maximizing the number of eligible patients included in the study. SV dose reduction was observed in 62 patients, and 48 patients had discontinued concomitant antihypertensive medications. The greatest reduction in the proportion of patients receiving SV combined with other antihypertensive agents occurred at the fourth month after dialysis initiation (39.8%). Patients receiving SV without dose reduction and in combination with other antihypertensive drugs had higher interdialytic and intradialytic blood pressure, when compared with patients receiving SV monotherapy or reduced/discontinued SV. The multivariate analysis identified diabetes mellitus [odds ratio [OR]: 3.085, 95% confidence interval [CI]: 1.137–8.376, p = 0.027], higher baseline N-terminal pro B-type natriuretic peptide (OR: 1.870, 95% CI: 1.109–3.152, p = 0.019), and higher interdialytic weight gain-to-dry weight ratio (OR: 4.083, 95% CI: 1.763–9.457, p = 0.001) as independent predictors of intradialytic hypotension. During follow-up, six composite events occurred in the SV combination or monotherapy group, while 13 composite events occurred in the SV dose reduction or discontinuation group. There was no significant difference between groups. Conclusion In real-world practice, the dose reduction or discontinuation of SV is common in HD patients. Clinicians should carefully balance individual risks and benefits, apply SV with caution, and closely monitor patients receiving this therapy.