Meta-analysis Of The Efficacy Of ANRI Versus ACEI/ARB In The Treatment Of Heart Failure With Chronic Renal Insufficiency

Objective:To systematically evaluate the effects of sacubitril-valsartan versus angiotensin converting enzyme inhibitors/angiotensin II receptor antagonists in patients with heart failure and chronic renal insufficiency.Methods:All major medical-related databases were searched comprehensively by computer,and the search time range was from the establishment of the database to December2020.The Chinese keywords were " chronic renal insufficiency,end-stage renal disease,uremia,heart failure,heart failure,left heart failure,heart failure,right heart failure,sacubitril-valsartan,and Noxintone" and the English keywords were "Renal Insufficiency,Chronic、Chronic Renal Insufficiencies、end-stage renal disease、uremia、Heart Failure、Cardiac Failure 、 sacubitril-valsartan 、 LCZ696 、 ANRI".The randomized controlled trials about heart failure complicated with chronic renal insufficiency treated by sacubitril-valsartan and ACEI/ARB were filtered strictly by two researchers and then the required data were extracted from that.The collected and summarized data were statistically analyzed using Rev Man 5.3software,and then TSA was used to estimate the sample size for some outcome indicators with small sample size and to test the stability of the results of Meta analysis.Results:Through computer searching and strictly filtering by researchers,7 articles were included in this paper and a total of 5842 patients were included.All of that were prospective randomized controlled trials(RCTs)in which the experimental group was sacubitril-valsartan and the control group was ACEI/ARB.Meta-analysis results showed that sacubitril-valsartan could significantly improve the effective rate for patients with heart failure complicated with chronic renal insufficiency[RR = 1.14,95% CI(1.00,1.31),P = 0.04];Sacubitril-valsartan could significantly improved renal compound outcome comparing with ACEI/ARB[RR =0.53,95% CI(0.35,0.79),P = 0.002];In the term of cardiovascular,sacubitril-valsartan could significantly increased LVEF levels comparing with ACEI/ARB[MD =-4.90,95%CI(-5.77,-4.03),P < 0.00001],decrease LVESD levels [MD =-4.10,95%CI(-5.17,-3.03),P < 0.00001],decrease LVEDD levels[MD =-4.90,95% CI(-5.77,-4.03),P < 0.00001],and decrease NTBNP levels [MD =-40.93,95% CI(-42.18,-39.67),P <0.00001].In the aspect renal,sacubitril-valsartan could significantly increase e GRF level comparing with ACEI/ARB[MD = 0.57,95% CI(0.02,1.13),P = 0.04].we carried out experimental sequential analysis on the outcome indicators,including effective rate、LVEF、LVESD、LVEDD in this reaserch,and the results indicate that all the accumulated Z values cross the traditional bound and cross the TSA threshold curve which indicated that the result is stable and reliable.Conclusions:1.Sacubitril-valsartan can improve the effective treatment rate,cardiac structure and protect cardiac function in patients with heart failure complicated with chronic renal insufficiency comparing with ACEI/ARB;2.Sacubitril-valsartan have more advantages than ACEI/ARB in protecting renal function in patients with heart failure and chronic renal insufficiency possibly.