Effectiveness and Safety of Sacubitril/Valsartan in Patients with Chronic Kidney Disease-A Real-World Experience

Background: data regarding the effectiveness and safety of sacubitril/valsartan in heart failure and reduced ejection fraction (HFrEF) patients with chronic kidney disease (CKD) are scarse.

Objective: to evaluate the effectiveness and safety of sacubitril/valsartan in HFrEF and CKD in a real-world population.

Methods: we included consecutive ambulatory HFrEF patients that initiated sacubitril/valsartan between February 2017 and October 2020, stratified by CKD (KDIGO stage 5 excluded).

Primary Outcomes: the incidence rate per 100 patient-years and the annualized length of stay (LOS) of acute decompensated HF hospitalizations (HFH).

Secondary Outcomes: all-cause mortality, NYHA improvement, and titration of sacubitril/valsartan.

Results: We included 179 patients, 77 with CKD, those being older (72 ± 10 vs. 65 ± 12 years, < 0.001), had higher NT-proBNP (4623 ± 5266 vs. 1901 ± 1835 pg/mL, < 0.001), and high anaemia incidence ( < 0.001). After 19 ± 11 months, a significant reduction in HFH adjusted incidence rate (57.5% decrease in CKD vs. 74.6%, = 0.261) was observed, with 5 days there was a reduction in annualized LOS in both groups ( = 0.319). NYHA improved similarly in both groups ( = 0.670). CKD patients presented non-significant higher all-cause mortality (HR = 2.405, 95%CI: [0.841; 6.879], = 0.102). Both groups had similar sacubitril/valsartan maximum dose achievement and drug withdrawal.

Conclusion: sacubitril/valsartan was effective on reducing HFH and LOS without affecting all-cause mortality in a CKD real-world population.