Effects of Sacubitril/Valsartan Versus Irbesartan in Patients With Chronic Kidney Disease

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Sacubitril/valsartan is known to reduce cardiovascular mortality in heart failure with reduced ejection fraction.
• Its impact on kidney function and cardiac biomarkers in patients with moderate to severe chronic kidney disease (CKD) was previously unknown.

Purpose of the Study:

• To evaluate the effects of sacubitril/valsartan on kidney function and cardiac biomarkers in patients with moderate to severe CKD.
• To compare sacubitril/valsartan with irbesartan in this patient population.

Main Methods:

• The UK HARP-III trial was a randomized, double-blind study involving 414 participants with an estimated glomerular filtration rate (GFR) between 20 and 60 mL/min/1.73 m².
• Participants were assigned to either sacubitril/valsartan or irbesartan, with measured GFR at 12 months as the primary outcome.

Main Results:

• No significant difference in measured GFR was observed between sacubitril/valsartan and irbesartan groups at 12 months (29.8 vs 29.9 mL/min/1.73 m²).
• Sacubitril/valsartan significantly reduced systolic and diastolic blood pressure and lowered levels of troponin I and N-terminal prohormone brain natriuretic peptide compared to irbesartan.
• No significant differences were found in urinary albumin:creatinine ratio or the incidence of adverse events.

Conclusions:

• Sacubitril/valsartan demonstrates comparable effects on kidney function and albuminuria to irbesartan over 12 months in patients with CKD.
• Sacubitril/valsartan offers additional benefits of blood pressure reduction and cardiac biomarker lowering in this population.