Renal Safety of Sacubitril/Valsartan: A Meta-Analysis of Randomized Controlled Trials

Link to article at PubMed

J Cardiovasc Pharmacol. 2022 Nov 18. doi: 10.1097/FJC.0000000000001379. Online ahead of print.


As a first-line therapy, sacubitril/valsartan (S/V) plays a significant role in the treatment of heart failure (HF). However, its effect on renal function is still uncertain. We searched PubMed, EMBASE, the Cochrane Library and Clinical Trials for randomized controlled trials (RCTs) to evaluate the effect of S/V on renal function in patients. The results are reported as the mean difference, relative ratio and 95% confidence intervals. A total of 13 RCTs were included (19367 patients). Among them, 11 studies focused on patients with HF, 1 on patients with acute myocardial infarction and 1 on patients with chronic kidney disease. We found that fewer worsening renal function (WRF) events, elevated creatine level events and severe hyperkalemia events (blood potassium >6.0 mmol/l) occurred in the S/V group than those in the renin-angiotensin-aldosterone system inhibitor (RASi) group. The estimated glomerular filtration rate (eGFR) decreased in both the S/V group and the RASi group, but the change was more obvious in the RASi group. There was no significant difference in hyperkalemia events (blood potassium >5.5 mmol/l) between the two groups. Subgroup analysis showed that with the extension of follow-up time (>6 months), WRF events occurred less frequently in the S/V group than in the RASi group. Existing evidence has shown that S/V is superior to RASi in general renal safety. Perhaps with the prolongation of treatment time, the advantages of S/V are more obvious.

PMID:36607717 | DOI:10.1097/FJC.0000000000001379

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