| ObjectiveTo explore the feasibility of sacubitril/valsartan in the treatment of maintenance hemodialysis patients with chronic heart failure.Method and materialsCollect the basic data of patients with reduced ejection fraction heart failure(HFr EF)who were on regular dialysis and took oral sacubitril/valsartan(ARNI)in our hospital’s kidney purification department from January to June 2019.Exclude patients who were unable to continue oral medication during follow-up,were unable to complete echocardiography,died,etc.The clinical data,biomarkers,laboratory value data(blood pressure,NT-pro BNP,Cr,BUN,UA,K,Ca,P),and echocardiographic data(LVEF,LVM,LVMI,LVDd,IVSTd,LVPWTd,LVSd,LAD,RVAW,RVDd,PAD,E/A,E/e,PAH,DLVDF,LVH,pericardial effusion)of the patients who completed the follow-up were statistically analyzed,and the subgroup analysis of different vascular access and different residual urine volume was also performed.The prospective self-comparison study design was adopted and statistical ana lysis was conducted with SPSS 22.0.The measurement data of normal distribution were represented by mean ± standard deviation(sx ±),the measurement data of non-normal distribution were represented by M(P25,P75),and the counting data were represented by N(%).Paired t test was used for those data with normal distribution,otherwise wilcoxon test was used,and paired chi-square test(Mc Nemar’s test)was used for the comparison of counting data before and after,and P < 0.05 was considered statistically significant.ResultThe study initially included 63 patients,excluding 14 patients who discontinued for various reasons(1 with low blood pressure and 1 with constipation),failed to complete echocardiography(6),and died during follow-up(2),and finally 49 patients completed.The follow-up period is 6 months.ARNI can reduce systolic blood pressure(145.1 ± 14.7,136.2 ± 13.5)mmhg,diastolic blood pressure(83.1 ± 14.6,80.1 ± 15)mmhg,NT-pro BNP [11560(4898,24265)-5608(1977,14373)] pg / ml;ARNI can increase LVEF(35.38 ± 6.59,48.25 ± 11.88)%,reduce LVMI(159.89 ±41.92,133.00 ± 36.09)g / m2,improve left ventricular and atrial remodeling,such as: LVDd(55.16 ± 6.23,52.11 ± 6.66)mm,IVSTd(12.15 ± 1.86,11.39 ± 2.35)mm,LVPWTd(11.96 ± 1.99,11.23 ± 2.19)mm,LVSd(41.23 ± 9.21,35.02 ± 7.70)mm,LAD(45.33 ± 5.65,42.30 ± 6.27)mm and reduce the occurrence of pericardial effusion and left ventricular hypertrophy;subgroup analysis shows that ARNI has different effects on the improvement of left ventricular function and structure in people with different vascular access;regardless of the type of vascular access,ARNI can effectively reduce the value of LVMI,ARNI can reducing the value of LVMI in the anuria group and the norma l urine group,was not obvious for the oliguria group.Adverse reactions were mainly hypotension(5 persons),constipation(1 person),hyperkalemia(11 persons),and no cough and edema occurred.The difference of Cr(1033.77±300.35,1043.27±309.78)umol/L,BUN(26.51±7.62,26.98±7.60)mmol/L,and K(4.83±0.74,4.98±0.69)mmol/L were not statistically significant(P > 0.05).ConclusionARNI can lower MHD blood pressure,lower NT-pro BNP levels,improve left ventricular function and left ventricular remodeling.The incidence of adverse reactions is low,and the levels of C r,BUN,and K are increased compared with the previous ones,but the difference is not statistically significant,so it is relatively safe to apply to this population in terms of renal function and electrolytes... |
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