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Abstract: PO2109

Renal Outcomes of Sacubitril-Valsartan vs. ACE Inhibitors and Angiotensin Receptor Blockers in Heart Failure: A Systematic Review and Meta-Analysis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Generoso, Eloisa Trina Cesante, St. Luke's Medical Center - Global City, Taguig, Metro Manila, Philippines
  • Dimagiba, Enrique L., St. Luke's Medical Center - Global City, Taguig, Metro Manila, Philippines
  • Crisostomo, Jacqueline Mariano, St. Luke's Medical Center - Global City, Taguig, Metro Manila, Philippines
  • Cabral, Brian Michael I., St. Luke's Medical Center - Global City, Taguig, Metro Manila, Philippines
Background

Chronic kidney disease is an important comorbidity in heart failure patients through elevation in blood pressure and activation of the RAAS. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers have been linked to beneficial effects on clinical outcomes of HF patients with CKD; however, they have been found to increase the risks for renal impairment. Clinical trials on the angiotensin receptor neprilysin inhibitor, sacubitril-valsartan, have found that it causes kidney dysfunction less frequently. This study determined the effect of sacubitril-valsartan on renal outcomes among HF patients compared to ACEi and ARBs alone.

Methods

A comprehensive literature search was done through electronic databases and readings until November 2019. This analysis incorporated randomized controlled trials in which indicators of renal function of patients on sacubtril-valsartan were compared to those of patients on reference drugs--estimated glomerular filtration rate, rise in serum creatinine, and increase in serum potassium.

Results

Four RCTs were included with a total of 14,377 subjects for analysis. Two of the studies used an ACEi (enalapril), while the remaining 2 used an ARB (valsartan). Compared with ACEi and ARBs, there was a nonsignificant difference between decline in renal function (RR 0.75, 95% CI 0.55 to 1.02; participants = 14377; studies = 4; I2= 53%), but a significant difference between rise in serum potassium level (RR 0.90, 95% CI 0.84 to 0.96; participants = 14334; studies = 4; I2= 66%), and elevation of serum creatinine level (RR 0.86, 95% CI 0.78 to 0.95; participants = 14070; studies = 3; I2= 72%).

Conclusion

In HF patients, sacubitril-valsartan shows possible reduction of risks for renal impairment, and definite reduction of risks for both increasing serum creatinine and hyperkalemia, as compared to ACEi and ARBs.

Non-increase of serum creatinine

Non-increase in serum potassium