Heart failure & cardiomyopathies
Effects of Sacubitril/Valsartan Across the Spectrum of Renal Impairment in Patients With Heart Failure
Authors' conclusion
One in 4 patients with HFrEF were classified as at least high KDIGO kidney risk; these individuals faced concordantly the highest risks of CV events. Sacubitril/valsartan exhibited consistent CV and kidney protective benefits as well as safety across the spectrum of baseline kidney risk.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) with available Kidney Disease Improving Global Outcomes (KDIGO) data (eGFR and urine-albumin-creatinine ratio)23% of total
- Participants
- 1,910 patients
- Comparison
- Sacubitril/valsartan vs enalapril across KDIGO risk categories
- Primary endpoint
- Composite of:
- CV death
- HF hospitalization
Methodological detailssubgroup analysis by baseline KDIGO risk
- Subgroup analysis by baseline KDIGO risk
Primary result
As reported in the abstract
Primary outcome, treatment effect across KDIGO risk
- Consistent effect of sacubitril/valsartan on primary outcome across KDIGO risk
- PInteraction = 0.31
Further findings
Renal composite (sustained eGFR decline ≥40% or end-stage kidney disease), sacubitril/valsartan vs enalapril across KDIGO risk
- Consistent effect across the spectrum of KDIGO risk
- P for interaction = 0.50
Primary composite (CV death or HF hospitalization) rate by baseline KDIGO risk (prognosis)
- Highest KDIGO risk categories had the highest rates of the primary composite outcome
- P < 0.001
- Rates in ascending order of KDIGO risk
- 7.6 per 100 person-years (95% CI: 6.5-9.0), 9.4 per 100 person-years (95% CI: 7.9-11.2), 14.9 per 100 person-years (95% CI: 12.7-17.6)
- Categories: low, moderate, high/very high KDIGO risk
Safety
- Similar safety profile of sacubitril/valsartan across KDIGO risk
Original publication
Effects of Sacubitril/Valsartan Across the Spectrum of Renal Impairment in Patients With Heart Failure. J Am Coll Cardiol. Published 6 April 2024. doi:10.
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