Efficacy And Safety Analysis Of Sacubitril/Valsartan In The Treatment Of Non-dialysis Patients With CKD Stage 3-4

Purpose:(1)To analyze the efficacy and adverse reactions of Sacubitril/valsartan in patients with chronic kidney disease(CKD)stage 3-4.(2)To analyze the efficacy of Sacubitril/valsartan in the complicated with heart failure(HF)and without heart failure.Methods:(1)Research subjects:Patients with non-dialysis CKD stage 3-4 who were admitted to the Department of Nephrology and Cardiology at the First Hospital of Jilin University from March2021 to October 2022 and treated regularly with sacubitril/valsartan for 3 months or more,and met the inclusion and exclusion criteria were retrospectively collected.(2)Grouping:Patients were divided into HF group and non-HF group according to the2018“Chinese Guidelines for the Diagnosis and Treatment of Heart Failure”.(3)Data collection:To collect the changes of blood pressure,serum creatinine,eGFR,albumin,24-hour urine protein quantification,serum potassium,uric acid,blood routine,left ventricular ejection fraction,left ventricular end-diastolic internal diameter,interventricular septal thickness,blood lipids,blood glucose and other related indexes before and after treatment in the enrolled patients and to record the adverse reactions.(4)Data analysis:Compare the changes of relevant indexes before and after treatment with sacubitril/valsartan in non-dialysis CKD stage 3-4 patients,and analyze its efficacy and safety in HF group and non-HF group.Results:(1)A total of 58 non-dialysis patients with CKD stage 3-4 were included in this study,31patients in the HF group and 27 patients in the non-HF group.After treatment with sacubitril/valsartan,eGFR increased by 5.11 ml/min/1.73m~2 compared with before(P<0.05),and serum creatinine decreased by 21.65 umol/L compared to before(P>0.05).Patients in the HF group had a decrease in serum creatinine by 15.1 umol/L and eGFR increased by 4.05ml/min/1.73m~2;patients in the non-HF group showed a decrease in serum creatinine by8.3umol/L and an increase in eGFR by 2.17 ml/min/1.73m~2after treatment,but none of them reached statistical significance(P>0.05).Changes in eGFR compared to baseline:3 patients(5.2%)had a decrease in eGFR of more than 50%(2 patients in the HF group and 1 patient in the non-HF group),all of them entered dialysis treatment;7 patients(12.1%)had a decrease in eGFR of 20～50%compared to baseline(2 patients in the HF group and 5 patients in the non-HF group),with 1 patient in the non-HF group entered dialysis treatment;the remaining patients had stable eGFR.(2)Sacubitril/valsartan can significantly reduce the blood pressure in patients with CKD stages 3-4,with mean seated systolic and diastolic blood pressure reduced by 11 mm Hg and 9mm Hg,respectively.Similar efficacies were observed in both HF and non-HF groups(P<0.01).(3)Sacubitril/valsartan can improve heart function and reverse ventricular remodeling in patients with CKD stages 3-4 and HF.left ventricular ejection fraction increased by 7.86%compared to before(P<0.01),including left ventricular ejection fraction improved by 7.60%(P=0.009)in the HFr EF group and 8.45%(P=0.016)in the HFmr EF+HFp EF group.Interventricular septum thickness was significantly decreased by 10.00(8.50,10.50)vs.10.00(9.00,11.00)mm(P<0.05),including 10.0(9.0,11.0)vs.10.0(9.0,10.0)mm in the HFr EF group(P=0.044)and 9.89±1.96 vs.10.44±1.51 mm in the HFmr EF+HFp EF group(P=0.179).There were no significant change in left ventricular end-diastolic internal diameter compared to before treatment in any groups(P>0.05).(4)After treatment with sacubitril/valsartan,serum potassium increased to between 5.5～6.0 mmol/L,6.0～6.5 mmol/L and>6.5 mmol/L were 5(8.6%),1(1.7%)and 1(1.7%)patients,respectively,with 1(1.7%)patient discontinuing treatment due to elevated blood potassium.3patients(5.2%)experienced dizziness,which improved after adjusting the dosage of antihypertensive drugs,and no angioneurotic edema,persistent cough or severe hypotension occurred.Conclusion:(1)Sacubitril/valsartan was able to delay the progression of renal function and reduce blood pressure in patients with non-dialysis CKD stage 3-4.(2)Sacubitril/valsartan could improve cardiac function and inhibit ventricular remodeling in patients with CKD3-4 combined with HF,with greater efficacy observed in the HFr EF group.(3)Compared with Renin-angiotensin system inhibitors,sacubitril/valsartan has fewer adverse reactions and well tolerated in patients with CKD stage 3-4,but blood potassium should be monitored.