Sacubitril/valsartan improves renal outcomes in HFpEF, chronic kidney disease
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Sacubitril/valsartan was superior to valsartan alone for reduction of renal events in patients with HF and preserved ejection fraction and chronic kidney disease, researchers reported.
Sacubitril/valsartan (Entresto, Novartis) also slowed the decline of estimated glomerular filtration rate (eGFR) in this population compared with valsartan alone, according to the researchers.
“In patients with HFpEF enrolled in the PARAGON-HF trial, treatment with sacubitril/valsartan resulted in fewer adverse renal events and slower decline in eGFR, despite a higher frequency of hypotensive events,” Finnian R. McCausland, MBBCh, MMSc, assistant professor of renal disease at Harvard Medical School, and colleagues wrote. “Notably, these renal benefits appear to extend across the spectrum of baseline renal function, providing an important therapeutic option to slow renal function decline in patients with heart failure.”
For this analysis of the PARAGON-HF trial, published in Circulation, investigators analyzed 4,822 patients with HFpEF and chronic kidney disease who were assigned to sacubitril/valsartan or valsartan alone to determine the renal effect of angiotensin-neprilysin inhibition on this population. The primary composite outcome was time to first occurrence of a reduction in eGFR of at least 50%, development of end-stage renal disease or death from renal causes. Median eGFR was 63 mL/min/1.73 m2 at the time of randomization.
Researchers observed that the composite outcome occurred in 1.4% of patients assigned to sacubitril/valsartan and 2.7% assigned to valsartan alone (HR = 0.5; 95% CI, 0.33-0.77). Treatment effect was not affected by baseline eGFR (< 60 vs. 60 mL/min/1.73 m2; P = .92), according to the study.
Moreover, the median drop in eGFR from randomization through the end of study was –2 mL/min/1.73 m2 per year among participants who received sacubitril/valsartan (95% CI, –2.2 to –1.9) and –2.7 mL/min/1.73 m2 per year for those on valsartan alone (95% CI, –2.8 to –2.5). The adjusted between-group difference was 0.6 mL/min/1.73 m2 per year (95% CI, 0.4-0.9; P < .001).
“Therapeutic benefits of sacubitril/valsartan with respect to renal outcomes are observed among patients with heart failure with preserved ejection fraction and appear to be similar across baseline kidney function,” the researchers wrote. “Sacubitril/valsartan may represent an important therapeutic option to slow kidney function decline in patients with heart failure with preserved ejection fraction.”
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