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Dramatic disease regression in a case of HFrEF with end-stage renal failure treated with sacubitril/valsartan and

Massimo Mapelli1,2, Valentina Mantegazza1,2, Cristina Ferrari1

  • 1Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy.

ESC Heart Failure
|March 13, 2023
PubMed

Insights

Guideline-directed heart failure medications showed significant benefits in a young woman with end-stage kidney disease on dialysis. Treatment led to reverse cardiac remodeling and improved heart function, demonstrating potential in this challenging patient group.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Evidence for guideline-directed, disease-modifying drugs for heart failure with preserved ejection fraction (HFrEF) in chronic kidney disease (CKD), particularly end-stage CKD, is limited.
  • Patients with HFrEF and end-stage renal disease on hemodialysis often face poor prognoses.

Observation:

  • A young woman with HFrEF and end-stage CKD on hemodialysis was treated with sacubitril/valsartan and SGLT2 inhibitors.
  • The patient had not previously used these disease-modifying HFrEF therapies.

Findings:

  • The patient experienced dramatic reverse cardiac remodeling and disease regression over 10 months.
  • Left ventricle and atrial volumes normalized, and ejection fraction improved to the normal range, confirmed by echocardiography and cardiac magnetic resonance.
  • Cardiac biomarkers and exercise tolerance also showed significant improvement, with no changes to her dialysis regimen or diuretic dosage.

Implications:

  • Sacubitril/valsartan and SGLT2 inhibitors may offer substantial benefits for HFrEF patients with end-stage CKD on dialysis.
  • This case highlights the potential for significant cardiac improvement in a population with limited therapeutic options.
  • Further research is warranted to explore the efficacy and safety of these drug classes in advanced CKD populations.

Keywords:
CKDChronic kidney diseaseEnd-stage renal diseaseHFrEFHaemodialysisHeart failure

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