Abstract
Abstract Background and Aims Sacubitril/valsartan, the first approved angiotensin receptor neprilisin inhibitor (ARNi), is the current cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF), reducing hospitalizations and mortality. However, in patients with chronic kidney disease stage 5D, who have the highest prevalence of congestive heart failure, its use is still not approved. The aim of this study was to evaluate the safety of sacubitril/valsartan in peritoneal dialysis (PD) patients with HFrEF. Method Multi-center cross-sectional cohort study including 5 PD patients with NYHA class II-IV HFrEF who started sacubitril/valsartan between 2017 and 2022. Demographic and clinical data were collected from the electronic records. Clinical, biochemical and echocardiographic parameters were compared before and after treatment initiation. Results A total of 5 patients (all male) were included with a mean age of 71±9 years and a median follow-up time of 16 months (IQR 22). The dose of sacubitril/valsartan was 24/26mg, 2 times per day in all patients. The indication to start PD was hypervolemia in all patients and the mean left ventricular ejection fraction at PD beginning was 35±8%. DPCA was the modality of choice in all patients and 4 were under icodextrin. All patients had coronary artery disease and 3 patients were obese and diabetic. All patients were taking furosemide and 4 patients were under a beta-blocker and a SGLT-2 inhibitor. During follow-up, left ventricular ejection fraction increased from 35±8% to 38±8% (P = .018) and median residual diuresis decreased 25 mL per month (IQR 66), but none of the patients became anuric. De novo hyperkalemia or hypotension did not develop in any of the patients. No significant difference in blood pressure profile was noticed. A major adverse cardiovascular event occurred in only one patient (myocardial infarction requiring coronary artery revascularization and hospitalization). No deaths were reported. Conclusion Our results suggest that ARNi can be used safely in patients under PD with major cardiovascular risk. Further randomized studies are warranted to confirm safety and clarify the benefit of this therapy in PD patients with HFrEF.
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