Clinical Efficacy Of Sacubitril/Valsartan In Maintenance Hemodialysis Patients With HFpEF

Objective:To study clinical efficacy of sacubitril/valsartan in maintenance hemodialysis patients with HFpEF.Methods:A total of 90 maintenance hemodialysis patients with HFpEF in the Department of Nephrology of Hefei Second People Hospital from January 2021 to January 2022 were collected,and they were divided into control group and observation group according to random number method.Both groups were given basic treatment such as routine blood pressure reduction,anemia improvement,and correction of electrolyte imbalance.On this basis,one group received ACEI/ARB as the control group,and the other group received sacubitril/valsartan as the observation group.The initial dose of sacubitril/valsartan is 50 mg bid,and the dose is gradually increased to 100 mg bid according to blood pressure and potassium level for 3 months.After 3 months of treatment,the relevant indexes such as NYHA,LVEF,LVEDD,LVESD,LVEDV,LVESV,E/e’,PAP,NT-pro BNP,6MWD,blood pressure level,serum potassium and incidence of adverse reactions before and after treatment were collected and compared.Results:1.A total of 90 MHD patients with HFpEF,no patients discontinued the drug during the follow-up period.There were no significant differences in general clinical data(age,dialysis age,sex,primary disease),NYHA,NT-pro BNP,serum potassium,serum creatinine,hemoglobin,LVEF,6MWD,SBP and DBP between the observation group and the control group before treatment(all P>0.05).2.After 3 months of treatment,according to clinical symptoms and NYHA,41 people were significantly effective,35 people were effective,and 14 people were ineffective,and the efficacy of the observation group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).3.After 3 months of treatment,LVEF in both groups was significantly improved,LVEDD,LVESD,LVEDV,E/e’ and PAP decreased compared to before,and the difference before and after treatment in the observation group was more significant than that in the control group,and the difference before and after treatment between the two groups was statistically significant(all P<0.05).After treatment,LVESV also decreased in both groups,and the difference between the observation group before and after treatment was statistically significant(P<0.05),while the difference between the control group was not statistically significant(P>0.05).4.After 3 months of treatment,the 6MWD of patients in both groups increased compared to before,and the NT-pro BNP decreased compared to before.The data difference before and after treatment in the observation group was higher than that in the control group,and the difference before and after treatment between the two groups was statistically significant(all P<0.05).5.After 3 months of treatment,the average SBP and DBP of the two groups decreased significantly compared to before.The difference before and after treatment in the observation group was significantly higher than that in the control group,and the difference before and after treatment between the two groups was statistically significant(all P<0.05),while the data before and after potassium treatment did not reflect the difference between the two groups,and there was no significant difference(all P>0.05).6.During the follow-up of treatment,the incidence of adverse reactions in the observation group was lower than that in the control group,and the difference between the groups was statistically significant(P<0.05).Conclusions:1.Sacubitril/valsartan effectively improved cardiac function in MHD patients with HFpEF,lowered NYHA grade,lowered NT-pro BNP level,and also played a role in reversing left ventricular remodeling.2.Sacubitril/valsartan effectively reduces blood pressure levels in MHD patients with HFpEF.3.Sacubitril/valsartan effectively improved exercise tolerance in MHD patients with HFpEF.4.In MHD patients with HFpEF,sacubitril/valsartan is relatively safe.