Meta-analysis Of The Efficacy And Safety Of Sacubitril-Valsartan In The Treatment Of End-stage Renal Disease Complicated Dialysis With Heart Failure

Objective:Sacubitril Valsartan has been widely used in the treatment of chronic heart failure.This study aims to evaluate the efficacy and safety of Sacubitril Valsartan in the treatment of dialysis with heart failure,and to provide evidence based basis for the treatment of renal dialysis patients with heart failure.Methods:Search English databases: Pub Med,Cochrane Library,Web of science,EBSCO;Chinese databases: CNKI,China Biomedical Literature Service System,WIP Chinese Science and Technology Journal Database,Wanfang Data Knowledge Service Platform,Wanfang Medical Network;The search time limit is from the establishment of the database to August 2022.Find the literature on the treatment of dialysis with heart failure by Sakubatravalsartan,extract the effective data,evaluate the literature quality according to the standards established by the Cochrane collaboration network,and use Revman 5.2 software for meta analysis.Results:A total of 12 RCT literatures meeting the standards were included,with a total of672 patients,including 338 in the test group and 334 in the control group.Meta analysis showed that sakubactrovalsartan could significantly reduce systolic blood pressure(SBP)[MD=-5.16,95%CI(-9.15～-1.17),P=0.01],diastolic blood pressure(DBP)[MD=-3.22,95%CI(-6.23 ～-0.21),P=0.04] in dialysis patients;Left ventricular ejection fraction(LVEF)[MD=5.99,95% CI(4.39～7.60),P<0.001],left ventricular end diastolic diameter(LVEDD)[MD=-4.42,95% CI(-5.83 ～ 3.00),P<0.001] Left ventricular end systolic diameter(LVESD)[MD=-4.33,95% CI(-5.03 ～-3.63),P<0.001],B-type natriuretic peptide(BNP)[SMD=-4.82,95% CI(-6.73 ～-2.92)had significant differences(P<0.05);in terms of renal function,it could reduce blood urea nitrogen(BUN)[MD=-2.05,95% CI(-3.95～-0.15),P=0.03],But there was no significant effect on serum creatinine(Scr)[SMD=-1.39,95% CI(-2.95～-0.16),P=0.08] and serum potassium clearance [MD=-4.82,95% CI(-0.16～0.302,P>0.05];It can improve the micro inflammation and reduce the high sensitivity C-reactive protein(hs CRP)[MD=-1.67,95% CI(-2.06 ～-1.28),P<0.001];It is effective to improve the symptoms of heart failure and NYHA graded cardiac function by at least 1 grade.The treatment effective rate is high [RR=1.38,95% CI(1.24-1.55),P<0.001].There is no difference in adverse reactions between the control group and the control group [RR=1.27,95% CI(0.61-2.67),P=0.52].Conclusion:Sakubatrasartan is safe and effective in the treatment of hemodialysis patients with heart failure,which can improve heart function and delay the progress of renal function.