Abstract
Heart failure (HF) is a major comorbidity in patients with end-stage renal disease (ESRD). The pathogenesis of HF in patients on renal replacement therapy represents the confluence of several traditional and nontraditional vascular risk factors, unique to the milieu of chronic kidney disease and the dialysis modality [1]. The purpose of this report is to describe the efficacy and safety of sacubitril/valsartan for an ESRD patient on hemodialysis therapy conmbined with heart failure with reduced ejection fraction (HFrEF). A 35-year-old woman was undergoing hemodialysis due to ESRD and suffering from heart failure with reduced ejection fraction. Because of worsening heart failure and hypertension, she was prescribed with sacubitril/valsartan at a dose of 50 mg twice a day, spironolactone at a dose of 20 mg three times a day and metoprolol at a dose of 23.75 mg once daily. There was a symptomatic improvement with the heart failure and reduction in NT-proBNP level, accompanied by a decrease of blood pressure after using sacubitric/valsartan. In conclusion, it is safe and effective to take sacubitril/valsartan in this hemodialysis patient with severe heart failure.
Highlights
Cardiovascular disease is the main cause of death in maintenance hemodialysis patients
The purpose of this report is to describe the efficacy and safety of sacubitril/valsartan for an end-stage renal disease (ESRD) patient on hemodialysis therapy conmbined with heart failure with reduced ejection fraction (HFrEF)
Sacubitril/valsartan consists of the neprilysin inhibitor sacubitril and the ARB, which strengthens the protective neuroendocrine system of the heart while inhibiting the renin-angiotensin-aldosterone system, was superior to enalapril in reducing the risks of death and of hospitalization for heart failure
Summary
Cardiovascular disease is the main cause of death in maintenance hemodialysis patients. The treatment of maintenance hemodialysis complicated with heart failure is inhibition of RAAS system (Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) and aldosterone antagonist), control of hypertension, Beta-blockers, statins, etc [7]. Sacubitril/valsartan consists of the neprilysin inhibitor sacubitril and the ARB, which strengthens the protective neuroendocrine system of the heart while inhibiting the renin-angiotensin-aldosterone system, was superior to enalapril in reducing the risks of death and of hospitalization for heart failure. The UK HARP-III trial (United Kingdom Heart and Renal Protection-III) has demonstrated that, compared with irbesartan, sacubitril/valsartan further reduces both blood pressure and biomarkers of cardiovascular risk (troponin I and N-terminal pro-B-type natriuretic peptide), and in a wide range of people with proteinuric chronic kidney disease, adding neprilysin inhibition to angiotensin II receptor blockade has no additional effect on kidney function or albuminuria [8] [9] [10]. The purpose of this case is to report the efficacy and safety of sacubitril/valsartan in the treatment of ESRD patients with HFrEF
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