Abstract
Purpose: ARNI (Sacubitril / Valsartan) is known to have natriuretic effects in addition to vasodilatory effects, cardiac hypertrophy, and antifibrosis. Therefore, it is considered to have a great effect on blood pressure and is used as an antihypertensive drug. However, the details of improvement of blood pressure changes in CKD patients are clearly unknown. Here we examine the clinical effects of ARNI administration in CKD patients by stage of renal function. Subject and Method: 41 CKD patients who started enresting for hypertension from September 27, 2021 to February 28, 2022, and 26 of them were able to follow up for a period of 3 months or more after oral administration. Patient profiles by renal function are 9 persons stage G3 (eGFR30–59), 4 persons stage G4 (eGFR15–29), 9 persons stage G5 (less than eGFR15), 3 persons stage G5D (during dialysis) PD, and 1 person HD + PD. Blood Pressure, eGFR, protein quantification, and NT-proBNP are measured before and after administration for a period of 3 months or more, and analysis was performed by two-way ANOVA with a mixed model using SPSS. In addition, ABPM was performed before and after ARNI administration in 9 of them (6 treatment-resistant hypertension), and the diurnal variation pattern, changes in proteinuria and renal function were also examined. Result: Before and after ARNI administration, blood pressure decreased and edema improved in most patients. There was no interaction with the rate of decrease in GFR (significance probability 0.972). In addition, urinary protein increased to 1.57 g/gCre (mean difference 95% confidence interval 0.175–2.966, significance probability 0.006 interaction). NT-proBNP decreased before and after administration. In stage G3, the dipper type of ABPM did not change, and the non-dipper type improved slightly. In stage G5 it was improved the degree of descent at night, and a change in category. However, in the case of peritoneal dialysis, the mean blood pressure did not improve, and the effect of pattern improvement was not observed. Discussion / Conclusion: ARNI was found to exert a strong antihypertensive effect on CKD patients that has not been treated with dialysis. And ARNI did not affect the antihypertensive effect even if there is residual urine during the dialysis period. In addition, edema can be expected to have a reducing effect regardless of proteinuria, and if blood pressure can be lowered firmly, it can also be expected to have a reducing effect on proteinuria.
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