Sacubitril-Valsartan Yields Mixed Outcomes in Heart and Kidney Health for HFrEF Patients

A recent study published in Kidney Research and Clinical Practice explores the nuanced effects of sacubitril-valsartan therapy on patients with heart failure with reduced ejection fraction (HFrEF), showing significant cardiovascular benefits but highlighting potential kidney health risks. The findings indicate that while sacubitril-valsartan therapy improves heart function, it may also negatively affect kidney function, posing a balancing act for healthcare providers managing patients with concurrent cardiac and renal concerns.

Cardiovascular Gains Offset by Kidney Function Decline

The study, led by Hyo Jeong Kim and colleagues at Yonsei University in South Korea, analyzed data from 512 patients with HFrEF who were treated with either sacubitril-valsartan or valsartan. Sacubitril-valsartan, a dual-action medication that enhances heart function by preventing neprilysin activity and blocking angiotensin II receptors, has shown efficacy in reducing cardiovascular mortality. However, its effects on kidney function remain a subject of study. The researchers examined how acute kidney injury (AKI) influenced the therapy’s impact, finding that patients on sacubitril-valsartan had greater improvements in heart function compared to those on valsartan, even with AKI. Nonetheless, the study also noted a similar rate of kidney function decline in both treatment groups, underscoring the need for careful patient monitoring.

In cohort 2, which included patients with AKI who received follow-up transthoracic echocardiography, those in the sacubitril-valsartan group experienced a 12.4% improvement in heart function, significantly higher than the 1.4% improvement seen in the valsartan group. However, kidney function metrics revealed declines of –1.76 in the sacubitril-valsartan group versus –0.20 in the valsartan group, suggesting that the heart health benefits of sacubitril-valsartan may come at the cost of renal health.

Implications for Patient Management in HFrEF

These findings are critical for clinicians treating patients with HFrEF, particularly those with a high risk of kidney complications. While sacubitril-valsartan appears to offer substantial cardiac benefits even among patients who develop AKI, its potential to exacerbate kidney decline presents a complex risk-benefit scenario. Balancing cardiovascular improvements with renal protection will require nuanced clinical decision-making, especially as the study found that nearly 16% of sacubitril-valsartan users experienced AKI compared to 12.5% of those on valsartan.

The study’s authors emphasize that “these findings offer valuable insights for managing patients with HFrEF and underscore the complexities involved in addressing both heart failure and kidney function.” The dual effects of sacubitril-valsartan, particularly in vulnerable HFrEF populations, highlight the importance of individualized treatment strategies to optimize both cardiac and renal outcomes, potentially informing future guidelines in heart failure management.