Kidney Week

Abstract: TH-PO0502

Sacubitril/Valsartan Improves Glycoalbumin in Patients with Diabetes on Hemodialysis: Potential Metabolic Benefit of Angiotensin Receptor-Neprilysin Inhibition

Session Information

• Dialysis: Novel Therapeutics and Medication Management
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Funakoshi, Satoshi, Nagasaki Kidney Center, Nagasaki, Japan

Satoshi Funakoshi, MD, PhD

• Hayashida, Masatoshi, Nagasaki Kidney Center, Nagasaki, Japan

Masatoshi Hayashida, MBBS

• Hashiguchi, Jyunichiro, Nagasaki Kidney Center, Nagasaki, Japan

Jyunichiro Hashiguchi, MD, PhD

• Maekawa, Akihiro, Nagasaki Kidney Center, Nagasaki, Japan

Akihiro Maekawa, MD

• Sawase, Kenji, Nagasaki Kidney Center, Nagasaki, Japan

Kenji Sawase, MD

Background

Sacubitril/valsartan (Entresto), an angiotensin receptor–neprilysin inhibitor (ARNI), is known for its cardioprotective and antihypertensive effects. Recent findings suggest it may also preserve DPP-4–sensitive peptides, potentially improving insulin sensitivity. However, its metabolic impact has not been evaluated in hemodialysis patients. In this population, glycoalbumin (GA) is a more reliable glycemic marker than HbA1c.

Methods

In this retrospective observational study, we included 9 maintenance hemodialysis patients with type 2 diabetes mellitus who received sacubitril/valsartan for ≥9 months without any changes in antidiabetic medications. GA levels, pre-dialysis blood pressure, and dry weight were assessed from 2 months before to 6 months after ARNI initiation. Statistical analysis was performed using the Friedman and Nemenyi tests.

Results

ΧGA levels significantly decreased over time (Χ²= 24.16, p = 0.0022), with a moderate effect size (Kendall’s W = 0.33). Although post hoc comparisons did not reach significance, a consistent downward trend was observed. No adverse events were reported. Pre-dialysis blood pressure slightly improved, and dry weight remained stable.

Conclusion

To our knowledge, this is the first report demonstrating improved glycemic control, as measured by GA, in diabetic hemodialysis patients treated with sacubitril/valsartan without altering antidiabetic therapy. These findings suggest that ARNI may offer a novel metabolic benefit in this high-risk population, beyond its established cardiovascular effects.

Funding

• Private Foundation Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20255nhm2q3q