| Objective Evaluate the effect of sacubitril valsartan on heart function,blood pressure and depressive symptoms in patients with maintenance hemodialysis combined with heart failure.Methods Retrospective analysis thirty-two patients with maintenance hemodialysis with chronic heart failure who were admitted to The Peoples Hospital of Guang Xi Zhuang Autonomous Region from January 2020 to June 2022 and treated with sacubitril valsartan.The indicators of patients before and after treatment were collected,which including general basic information(gender,age,underlying diseases,dialysis age),office systolic blood pressure and diastolic blood pressure,clinical biochemical indexes before dialysis(Cr,BUN,PTH,K,Ca,Pi,ALB,HG and Kt/V),echocardiographic parameters(LVEF,LVDD,LVSD,IVSTd,LVPWTd),NYHA,SDS,BECK-Ⅱ and KCCQ-12.And then analyze the changes of various indexes before and after treatment of sacubitril valsartan.Adverse events were recorded during the treatment,which including symptomatic hypotension,hyperkalemia,irritating dry cough,angioedema,rehospitalization for heart failure,and death.Results Heart failure symptoms,NHYA grading,LVEF(48.91±15.45 vs 54.06±14.64,t =-3.75),HB(98.59±17.11 vs 107.28±26.74,t =-2.36)was improved significantly,KCCQ-12 score(55.31 ± 15.33 vs 76.66 ± 7.43,t =-12.69)was significantly increased,LVSD(40.78±8.82 vs 37.18±9.41,t = 4.57),LVDD(54.46±6.34 vs 51.72±7.68,t = 3.11)decreased significantly(P < 0.05)in hemodialysis patients after treatment.But LVPWTd(11.87 ± 1.96 vs 12.09 ± 2.01,t =-1.02),IVSTd(12±2.14 vs 12±2.14,t = 0.00),Kt/V(1.25±0.05 vs 1.26±0.04,t = 0.71)were not significantly changed(P > 0.05).Besides systolic blood pressure(155.34±16.18 vs 138.75 ± 7.68,t = 12.53)and diastolic blood pressure(87.68 ± 13.04 vs79.18±8.48,t = 5.22)in the consultation room were significantly decreased after treatment with sacubitril valsartan(P < 0.05).No patient developed symptomatic hypotension.SDS score(51.91±3.01 vs 47.77±3.52,t = 7.51)and BECK-Ⅱscore(15.63±2.91 vs 12.06±2.06,t = 13.42)decreased significantly after treatment(P <0.05).However there were not significantly different in Ca(2.13±0.24 vs 2.17±0.27,t =-0.75),K(4.30±0.58 vs 4.43±0.71,t =-0.86),Pi(1.69±0.44 vs 1.72±0.64,t =-0.86),PTH [252.40(137.57,409.67)vs 258.15(140.75,458.53),Z =-0.22],Cr(680.59±211.99 vs 732.56±235.14,t =-1.37),BUN(18.83±5.97 vs 18.29±6.53,t= 0.35),ALB(35.76±5.95 vs 36.76±7.55,t = 0.81)before dialysis(P > 0.05).Conclusion Sacubitril valsartan can improve the symptoms of heart failure,improve the classification of cardiac function,depressive symptoms,the quality of life,and reverse ventricular remodeling.Sacubitril valsartan can effectively and smoothly reduce blood pressure in hemodialysis patients.Generally Sacubitril valsartan is safe in hemodialysis patients and does not significantly increase the risk of hyperkalemia,symptomatic hypotension,and heart failure rehospitalization and death. |
PDF Full Text Request