Secondary analysis
Effects of Sacubitril/Valsartan Across the Spectrum of Renal Impairment in Patients With Heart Failure
- Secondary analysis of the PARADIGM-HF randomised trial
- subgroup analysis by baseline Kidney Disease Improving Global Outcomes (KDIGO) risk
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 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
Primary result
As reported in the abstract
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
Safety across KDIGO risk
- Similar safety profile of sacubitril/valsartan across KDIGO risk
Original publication
Summarised from the published abstract; every number is checked against it