Evaluation Of The Efficacy Of Sacubitril/valsartan In The Treatment Of End-stage Renal Disease With Regularity Of Hemodialysis And Heart Failure

Objective:This study was designed to evaluate the clinical efficacy of sacubitril/valsartan in the treatment of end-stage renal disease patients with regular hemodialysis and heart failure in clinical practice,and to provide theoretical basis and data support for the treatment of renal failure patients with heart failure.Methods:From June 2020 to December 2022,patients with chronic kidney disease complicated with heart failure who were treated in The China-Japan Union Hospital Of Ji Lin University and The Second Bethune Hospital Of Ji Lin University were selected.The study was divided into two groups(the sarcubacil/valsartan group and the control group).The sarcubacil/valsartan group was a group of patients who underwent regular hemodialysis and received sarcubacil/valsartan treatment.A total of44 patients were included.The dose of sarcubacil/valsartan started at 50 mg daily and increased to 50 mg daily or 100 mg daily under tolerance for 2-3 days;The control group consisted of 63 patients who did not receive regular hemodialysis and were not treated with sarcubacil/valsartan.The two sets of routine treatments(diuresis,cardiac strengthening,vasodilation,etc.)are the same.Left ventricular ejection fraction(LVEF),left ventricular width(LVD),N-terminal pro-brain natriuretic peptide(NT-pro BNP),hemoglobin(Hb),red blood cell distribution width(RDW),platelet distribution width(PDW)and other indicators were evaluated before treatment and after 12 weeks of treatment.Inter-group difference analysis was performed between the two groups,and intra-group difference analysis was performed between the two groups before treatment and after 12 weeks of treatment.Results:1.Changes of blood pressure after 12 weeks of treatment: there was no significant difference in systolic blood pressure between the two groups before and after 12 weeks of treatment(p>0.05);Compared with the control group,the systolic blood pressure of sacubitril/valsartan group decreased significantly after 12 weeks of treatment(p<0.05).The systolic blood pressure of sacubitril/valsartan group before treatment was significantly different from that after 12 weeks of treatment(p<0.05),while that of control group before treatment was not significantly different from that after 12 weeks of treatment(p<0.05).There was no significant difference in diastolic blood pressure between the two groups before and 12 weeks after treatment(p>0.05)There was no significant difference in diastolic blood pressure between the two groups(p>0.05).There was no significant difference in diastolic blood pressure between the two groups before treatment and after 12 weeks of treatment(p>0.05).2.The change of NT-pro BNP after 12 weeks of treatment: there was no significant difference between the two groups before treatment(p>0.05);After 12 weeks of treatment,there was significant difference in NT-pro BNP between the two groups(p<0.05);After 12 weeks of treatment,NT-pro BNP in sacubitril/valsartan group decreased compared with that before treatment,while NT-pro BNP in control group increased compared with that before treatment,and there was significant difference in NT-pro BNP change between the two groups(p<0.05);There was significant difference in NT-pro BNP between the two groups before treatment and after 12 weeks of treatment(p<0.05).3.The change of LVEF after 12 weeks of treatment: There was no significant difference in LVEF between the two groups before and after 12 weeks of treatment(p>0.05);After 12 weeks of treatment,LVEF in sacubitril/valsartan group was higher than that before treatment,while LVEF in control group was lower than that before treatment,and the difference of LVEF change was significant(p<0.05).There was no significant difference in left ventricular ejection fraction between the two groups after12 weeks of treatment(p>0.05).4.Changes of left ventricular width after 12 weeks of treatment: There was no significant difference in left ventricular width between the two groups before treatment and after 12 weeks of treatment(p>0.05).After 12 weeks of treatment,the left ventricular width of sacubitril/valsartan group was slightly decreased,but the difference was not significant(p>0.05).After 12 weeks of treatment,the left ventricular width of the control group increased slightly,but the difference was not significant(p>0.05).5.Hemoglobin changes after 12 weeks of treatment: There was no significant difference in hemoglobin between the two groups before treatment and after 12 weeks of treatment(p>0.05);After 12 weeks of treatment,there was no significant difference in hemoglobin between the two groups(p> 0.05).6.Changes of red cell volume distribution width after 12 weeks of treatment:There was no significant difference in red cell volume distribution width between the two groups before and after 12 weeks of treatment(p>0.05);After 12 weeks of treatment,the volume distribution width of red blood cells in both groups increased,but the increase in the control group was more significant(p<0.05).After 12 weeks of treatment,the red cell volume distribution width was significantly increased in the control group compared with that before treatment,while the difference was not significant in the sacubitril/valsartan group(p>0.05).7.Changes of platelet volume distribution width after 12 weeks of treatment:There was no significant difference between the two groups before and after 12 weeks of treatment(p>0.05);There was no significant difference in the increase or decrease of platelet volume distribution width between the two groups after 12 weeks of treatment(p>0.05).After 12 weeks of treatment,there was no significant difference between the two groups(p>0.05).Conclusion:1.Sacubitril/valsartan can effectively reduce NT-pro BNP levels in hemodialysis patients with end-stage renal disease and heart failure.2.Sacubitril/valsartan is effective in reducing systolic pressure in patients with end-stage renal disease on hemodialysis and heart failure.3.Sacubitril/valsartan effectively delays the increase in red cell volume distribution width in end-stage renal disease hemodialysis patients with heart failure.4.Sacubitril/valsartan is beneficial for the heart and kidney in patients with end-stage renal disease and hemodialysis complicated with heart failure.