Sacubitril/Valsartan better than ACEI/ARB in lowering mortality risk in HFrEF patients with CKD

A recent study published in the Cardiovascular Drugs and Therapy Journal found that sacubitril/valsartan has lower all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) over a 12-month follow-up period. Wei-Chieh Lee and team undertook this study to investigate the differential effects of sacubitril/valsartan and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEIs/ARBs) on clinical and renal outcomes in CKD patients HFrEF.

The study enrolled 3735 patients with HFrEF and a mean left ventricular ejection fraction of 27.56% who had been prescribed sacubitril/valsartan or ACEI/ARB. The study used propensity score matching to compare the clinical and renal outcomes between the two groups of patients with and without CKD over the 12-month follow-up period.

The highlights of the study were:

There were no significant differences in clinical and renal outcomes between the sacubitril/valsartan and ACEI/ARB groups in patients without CKD. 

In the patient population that had CKD and were prescribed ACEI/ARB, the study found a 14.89% incidence of all-cause mortality over the 12-month follow-up period. On the other hand, in patients with CKD who were prescribed sacubitril/valsartan, the study found a 10.50% incidence of all-cause mortality over the same follow-up period, which was lower. 

The incidence of acute kidney injury (AKI), heart failure hospitalization, and cardiovascular mortality did not differ between the two groups.

The study concludes that sacubitril/valsartan may have a lower all-cause mortality compared to ACEI/ARB in symptomatic HFrEF patients with CKD. However, the Authors of this study also noted that further prospective randomized studies are warranted to confirm these findings.

Source:

Lee, W.-C., Liao, T.-W., Chen, T.-Y., Fang, H.-Y., Fang, Y.-N., Chen, H.-C., Lin, Y.-S., Chang, S.-H., & Chen, M.-C. (2023). Sacubitril/valsartan improves all-cause mortality in heart failure patients with reduced ejection fraction and chronic kidney disease. In Cardiovascular Drugs and Therapy. Springer Science and Business Media LLC. https://doi.org/10.1007/s10557-022-07421-0