Key result
ARNI reduces worsening renal function by ~17% compared with RAAS inhibitors alone in heart failure.
Why the study?
Although angiotensin receptor neprilysin inhibitors (ARNi) improve cardiovascular outcomes in patients with HF, their effects on kidney function in this population remain incompletely characterized.
Does neprilysin inhibition combined with RAAS inhibition (sacubitril/valsartan or omapatrilat) reduce the incidence of worsening renal function and adverse renal outcomes compared with RAAS inhibitors alone in patients with heart failure?
Meta-Analysis (n=31,574)
Randomized controlled trials
Does neprilysin inhibition combined with RAAS inhibition (sacubitril/valsartan or omapatrilat) reduce the incidence of worsening renal function and adverse renal outcomes compared with RAAS inhibitors alone in patients with heart failure?
In patients with heart failure, ARNi therapy reduces the risk of worsening renal function, >50% eGFR decline, acute kidney injury, and severe hyperkalaemia compared with RAAS inhibitors alone, though at the expense of increased symptomatic hypotension.
Answers are grounded in this paper and cite their sources.
ARNi reduce worsening renal function in heart failure; extends prior cardiovascular benefits to renal protection in meta-analysis of RCTs.
INTRODUCTION: Angiotensin receptor neprilysin inhibitors (ARNi) significantly improve cardiovascular outcomes in patients with heart failure (HF). Their effects on kidney function in this population remain incompletely characterized. A systematic review and meta-analysis were performed to explore the impact of ARNi on renal outcomes. METHODS: MEDLINE, Embase, and PubMed databases were searched for randomized trials comparing ARNi with renin-angiotensin-aldosterone system inhibitors (RAASi) alone. Outcomes included the incidence of worsening renal function, hyperkalaemia, hypotension, >50% decrease in eGFR, end-stage renal disease, rise in serum creatinine >2.5 mg/dl, and acute kidney injury. Risk of bias was assessed using the ROB 2.0 tool. RESULTS: Fifteen studies with 31 574 individuals were included. Mean age was 67 years and 33% were female. ARNi significantly reduced the incidence of worsening renal function events [relative risk (RR): 0.83, 95% confidence interval (CI): 0.71-0.96; P = .01], corresponding to 13 fewer events per 1000 patients. ARNi were also associated with a lower risk of >50% decline in eGFR (RR: 0.61, 95% CI: 0.47-0.78; P < .001) and acute kidney injury events (RR: 0.82, 95% CI: 0.69-0.97; P = .024) compared with RAASi alone. There was no significant difference in the incidence of hyperkalaemia >5.5 mmol/L between groups, while ARNi were associated with a higher incidence of symptomatic hypotension (RR: 1.54, CI 95%: 1.35-1.76; I2 = 69%; P < .001). CONCLUSIONS: ARNi are associated with a lower risk of adverse renal outcomes compared with RAASi in patients with heart failure. However, this benefit should be interpreted alongside an increased risk of symptomatic hypotension.
No takes yet. Share an insight, caveat, or question.
Travlos et al. (2026) conducted a meta-analysis in Heart failure (HFrEF, HFmrEF, and HFpEF) (n=31,574). Angiotensin receptor neprilysin inhibitors (sacubitril/valsartan or omapatrilat) vs. Renin-angiotensin-aldosterone system inhibitors (ACEi or ARB) alone was evaluated on Incidence of worsening renal function (as defined in each study) (RR 0.83, 95% CI 0.71-0.96, p=0.013). Angiotensin receptor neprilysin inhibitors reduced worsening renal function compared with RAAS inhibitors alone in heart failure patients.
Synapse has enriched 10 related papers. Consider them for comparative context: