Heart failure & cardiomyopathiesMeta-analysis
Efficacy and Safety of Angiotensin Receptor–Neprilysin Inhibition in Heart Failure Patients with End-Stage Kidney Disease on Maintenance Dialysis: A Systematic Review and Meta-Analysis
- Systematic review and meta-analysis
- random effects model
Authors' conclusion
This meta-analysis provided insights into the benefits of ARNI in HF patients with ESKD undergoing dialysis by improving left ventricular function, reversing left ventricular remodelling, and reducing the risk of all-cause mortality, without increasing the risk of HF hospitalizations, severe hyperkalaemia, and symptomatic hypotension.
Study context
- Population
- Heart failure (HF) patients with end-stage kidney disease on maintenance dialysis
- Participants
- 2,494 patients · 26 studies
- Comparison
- Angiotensin receptor-neprilysin inhibitor (ARNI) vs conventional treatment
Pooled result
LVEF
Mean difference
4.03 %
95% CI 2.90–5.16
ARNI vs Conventional
mean difference 4.03 % (95% CI 2.90–5.16)
As reported in the abstract
- Left ventricular ejection fraction (LVEF) mean change before vs after ARNI
- 8.05% (95% CI 5.57-10.54)
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality | 0.64 (0.45–0.92) | P = 0.01 | |
| HF hospitalization | 0.71 (0.43–1.18) | P = 0.19 | |
| 0.512Relative risk (log scale) |
LV end-systolic diameter, LV mass index, left atrial diameter, E/e' ratio
- Improved with ARNI
- P < 0.05
Safety
Severe hyperkalaemia, symptomatic hypotension
- Severe hyperkalaemia risk not significantly increased
- P = 0.33
- Symptomatic hypotension risk not significantly increased
- P = 0.53
Original publication
Efficacy and Safety of Angiotensin Receptor–Neprilysin Inhibition in Heart Failure Patients with End-Stage Kidney Disease on Maintenance Dialysis: A Systematic Review and Meta-Analysis. Eur J Heart Fail. Published 9 September 2024. doi:10.1002/ejhf.3454
Summarised from the published abstract; every number is checked against it