Sacubitril/Valsartan Safe, Effective Among CHF Patients on Maintenance Hemodialysis

Heart function and heart structure were safely and effectively managed and improved among 54 patients living with chronic heart failure (CHF) and undergoing maintenance hemodialysis (MHD) who received treatment with sacubitril/valsartan, according to recent study findings in American Journal of Translational Research.

The patients in this retrospective self-controlled study received care between January 2020 and June 2021 at the Blood Purification Center of the First Affiliated Hospital of Chongqing Medical University in China. Following discharge, for this study, they were followed up with on a monthly basis by telephone for an average of 6 months. Clinical data collected included body mass index, dialysis age, urea clearance rate, and predialysis systolic (SBP) and diastolic blood pressures (DBP). Biochemical data collected included blood phosphorus, blood creatinine, urea nitrogen, and hemoglobin. The mean (SD) patient age was 50.9 (14.6) years, most (63%) had New York Heart Association class III disease, the mean SBP was 151 (19) mm Hg before treatment, and the mean DBP was 90 (21) mm Hg before treatment.

“Recent research has confirmed that sacubitril/valsartan can effectively reduce the mortality and hospitalization rate of patients with CHF combined with reduced ejection fraction,” the study authors wrote. “It is one of the most promising drugs in CHF treatment. However, there are insufficient clinical data on the efficacy and safety of this drug in MHD patients complicated with CHF.”

Before treatment, there were 6 cases of hyperkalemia, 5 of hypotension, 12 of angina, 5 myocardial infarctions (MI), 4 cerebral infarctions, 2 cerebral hemorrhages, and 2 HF-related hospitalizations. After treatment with sacubitril/valsartan, although cases of hyperkalemia, hypotension, and hospitalization rose to 15 (P = .029), 6 (P = .750), and 10 (P = .014), respectively, occurrences of MI, cerebral infarction, and cerebral hemorrhage dropped to 3, 2, and 1, respectively.

Among the study participants, the maintenance dosages of sacubitril/valsartan were 100 mg twice daily in 75.9%, 50 mg twice daily in 14.8%, and 200 mg twice daily in 9.3%. The dose was adjusted based on blood pressure and blood potassium, the authors wrote.

Hemoglobin, serum calcium, serum phosphorus, intact parathyroid hormone, predialysis serum creatinine, predialysis urea nitrogen, and albumin levels did not change significantly following sacubitril/valsartan treatment (P > .05). However, left anteroposterior atrial diameter, left ventricular end diastolic diameter, SBP, and DBP were both reduced and left ventricular ejection fraction (LVEF) increased (P < .001) compared with measures taken before initiation with sacubitril/valsartan. These findings were considered statistically significant. Activity tolerance among patients also improved.

“As one of the most common complications in patients with end-stage renal disease, HF is a serious threat to patients’ life safety and affects their quality of life,” the authors wrote. “Cardiovascular and cerebrovascular events are the main causes of death in MHD patients. How to improve patients’ prognosis is a persistent concern of hemodialysis doctors.”

They also noted that following sacubitril/valsartan treatment, “the calibration value of other oral antihypertensive drugs decreased, indicating the antihypertensive effect of [sacubitril/valsartan], which may add new options for the treatment of ‘refractory hypertension.’”

Future studies will need to further investigate their findings due to the small sample size and the study’s observational nature. But overall, they concluded, sacubitril/valsartan shows great potential to improve left atrial structure, LVEF, and cardiac function, and reduce incidences of angina pectoris and hospitalization among patients on maintenance hemodialysis who have CHF.

Reference

Wen Y, Xia Y, Gong Y. Effects and safety of sacubitril/valsartan (SV) on heart function and blood pressure in maintenance hemodialysis (MHD) patients. Am J Transl Res. 2022;14(5):3439-3447.