Abstract
Objectives: Blood pressure and volume control is required in patients undergoning peritoneal dialysis (PD). Residual renal function play an important role in PD vintage and mortality, and also dependent on blood pressure and volume control. Sacubitril-valsartan, and angiotensin receptor-neprilysin inhibitor (ARNI), has been approved to use for blood pressure control in Japan. However, the antihypertensive effect of sacubitril-valsartan in PD patients is not well known. Thus, the present study was designed to determine the efficacy and safety of ARNI in hypertensive patients undergoing PD. Methods: Hypertensive end-stage kindey disease (ESKD) patients and systolic blood pressure of more than 135 mmHg despite of other hypertensive drugs was administered sacubitril-valsartan. Clinical parameters such as home blood pressure, body weight, brain natriuretic peptide and urine volume was monitored. Body fluid composition was analyzed by bioimpedance method. Results: Eleven PD patients received sacubitril-valsaltan at a dose between 100–400 mg. Blood pressure decreased in seven patients. Then, those who responded (Res group, n = 7) to sacubitril-valsartan was compared to those did not responded (Non-Res group, n = 4). Significantl decrease in blood pressure was observed in Res group by 16.9 ± 10.2mmHg, while increase was observed in Non-Res group by 10.8 ± 7.8mmHg. Plasma BNP tended to decrease in both groups but did not reach to a level of significance. Body weight, urine volume, extracelullar water / total body water did not change in either group. Conclusions: Antihypertensive effect of sacubitril-valsartan was observed in limited patients of ESKD patients undergoing PD. However, BNP was reduced in most patients treated with sacubitril-valsartan with no adversed effects. Although ARNI could be beneficial antihypertensive drugs for cirtain hypertensive ESKD patients undergoing PD, further study is requied.
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