Related Experiment Video
Updated: May 7, 2025
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Angiotensin Receptor-Neprilysin Inhibitor in Heart Failure Patients With Renal Dysfunction
Xiaogang Zhu1, Xialing Li1, Lingxuan Zhu2
1Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing, China.
Insights
Sacubitril/valsartan may benefit heart failure patients with kidney issues by slowing kidney function decline. However, careful risk-benefit assessment is needed due to limited evidence on hyperkalemia and worsening renal function.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Heart failure (HF) and renal dysfunction frequently coexist, complicating patient management and outcomes.
- The cardiorenal syndrome presents significant clinical challenges, necessitating effective therapeutic strategies.
Purpose of the Study:
- To evaluate the role of sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), in managing heart failure patients with renal dysfunction.
- To explore the potential renal protective effects of sacubitril/valsartan in this patient population.
Main Methods:
- Review of recent reports and clinical experience regarding sacubitril/valsartan use in HF with reduced ejection fraction and concomitant renal dysfunction.
- Analysis of the drug's impact on estimated glomerular filtration rate (eGFR) compared to traditional therapies.
Main Results:
- Sacubitril/valsartan may slow the decline in eGFR in HF patients with renal dysfunction compared to angiotensin-converting enzyme inhibitors.
- Evidence for reducing the absolute risk of hyperkalemia and worsening renal function with ARNI use remains limited.
Conclusions:
- The use of sacubitril/valsartan in HF patients with renal dysfunction requires a careful balance of potential benefits and risks.
- An individualized treatment approach and further research into cardiorenal mechanisms are crucial for optimizing management.
Abstract:
Heart failure (HF) and renal dysfunction often coexist and interact in many complex and bidirectional pathways, leading to detrimental effects on patient outcomes. The treatment of HF patients with renal dysfunction presents a significant clinical challenge. Interestingly, sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), may have beneficial effects on cardiac and renal outcomes in patients with HF with reduced ejection fraction, particularly by slowing the rate of decrease in the estimated glomerular filtration rate compared to a single angiotensin-converting enzyme inhibitor. Recently, more reports have emphasized the renal protection of sacubitril/valsartan in patients with HF. In HF patients with renal dysfunction, however, there is no strong evidence supporting the use of sacubitril/valsartan to reduce the absolute risk of hyperkalemia and worsening renal function; therefore, the administration of ARNI requires a careful balance between the benefits and risks. Furthermore, the lack of evidence-based management highlights the importance of an individualized approach based on published experience and multidisciplinary collaborations, as well as underlines the need for in-depth studies investigating the underlying mechanisms in cardiorenal interactions with a focus on treatments.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
01:25Antihypertensive Drugs: Direct Renin Inhibitors
01:22Heart Failure Drugs: Diuretics
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
01:33Hormonal Regulation