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Abstract: TH-PO195

Cardiovascular Benefits and Safety of Sacubitril-Valsartan in ESKD: A Systematic Review and Meta-Analysis

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Charkviani, Mariam, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Krisanapan, Pajaree, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Craici, Iasmina, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States

End-stage kidney disease (ESKD) patients often experience heart failure, which significantly contributes to their high mortality rates. Despite the crucial role of sacubitril-valsartan in heart failure management, limited data exists on its cardiovascular benefits and safety in ESKD patients. This systematic review aims to assess the efficacy and safety of sacubitril-valsartan compared to standard care in ESKD patients on dialysis, addressing this critical knowledge gap.


A comprehensive search of was conducted in Embase, MEDLINE, and Cochrane databases though February 2022 to identify studies assessing cardiovascular and/or safety outcomes of sacubitril-valsartan in ESKD patients on dialysis. Effect estimates were derived and consolidated using a random-effect model and the generic inverse variance approach.


Analysis of 12 studies involving 799 eligible ESKD patients demonstrated notable improvements in left ventricular ejection fraction (LVEF) with sacubitril-valsartan compared to the control group, resulting in a pooled mean difference (MD) of 6.58 (95% CI 1.86, 11.29). Subgroup analysis revealed significant differences between heart failure patients with reduced ejection fraction (HFrEF) or moderately reduced ejection fraction (HFmrEF) versus preserved ejection fraction (HFpEF) (p<0.0001). LVEF significantly improved in patients with LVEF <50% (HFrEF and HFmrEF) with an MD of 12.42 (95% CI 9.39, 15.45). However, patients with LVEF >50% (HFpEF) did not show a statistically significant effect, reporting an MD of 2.6 (95% CI 1.15, 6.35). Notably, sacubitril-valsartan significantly enhanced LVEF in HFrEF patients, with a pooled MD of 13.8 (95% CI 12.04, 15.82). Safety analysis revealed no significant differences in the incidence of hyperkalemia (pooled odds ratio [OR] 0.72; 95% CI 0.38, 1.36) or hypertension (pooled risk ratio [RR] 1.03; 95% CI 0.36, 2.98) between sacubitril-valsartan and standard care groups. No cases of angioedema were reported.


Our systematic review suggests that sacubitril-valsartan, compared to standard care, provides benefits to ESKD patients with HFrEF and HFmrEF by improving LVEF, without increasing the risk of hyperkalemia, hypotension, or angioedema.