The efficacy and safety of sacubitril/valsartan in chronic kidney disease: a systematic review and meta-analysis.
A systematic review and meta-analysis of six randomized trials (6217 CKD patients) found that sacubitril/valsartan improved renal function and conferred cardiovascular benefits versus ACEi/ARB, with hypotension as the main safety signal and no increase in hyperkalemia.
Background
Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor, benefits heart failure by blocking degradation of natriuretic peptides and inhibiting renin-angiotensin-aldosterone system activation, pathways also relevant to chronic kidney disease pathophysiology. Its effects specifically in CKD had remained unclear, prompting this meta-analysis.
Study design
The authors searched Embase, PubMed, and the Cochrane Library for randomized controlled trials comparing sacubitril/valsartan with ACEi/ARB in CKD patients with an eGFR below 60 mL/min/1.73 m2. Six trials with a total of 6217 patients were included, with risk of bias assessed using the Cochrane Collaboration tool and effect sizes expressed as odds ratios with 95% confidence intervals.
Key findings
Sacubitril/valsartan reduced the risk of cardiovascular death or heart failure hospitalization (OR 0.68, 95% CI 0.61 to 0.76) and lowered the incidence of serum creatinine elevation (OR 0.79, 95% CI 0.67 to 0.95). In a subgroup analysis with longer follow-up, it significantly reduced the number of patients with more than a 50% reduction in eGFR (OR 0.52, 95% CI 0.32 to 0.84). The reduction in end-stage renal disease incidence (OR 0.59) was not statistically significant. Hypotension was more frequent (OR 1.71, 95% CI 1.15 to 2.56), while hyperkalemia risk was not increased (OR 1.09, 95% CI 0.75 to 1.60).
Clinical implications
The analysis suggests sacubitril/valsartan may be a promising option for patients with CKD, improving renal function and providing cardiovascular benefit without serious safety issues beyond an increased risk of hypotension. The authors caution that further large-scale randomized controlled trials are needed to confirm these conclusions.
Category
Research
Source
Int Urol Nephrol
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