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Updated: Sep 13, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Clinical Effectiveness of Sacubitril/Valsartan in Heart Failure Patients With Coexisting Chronic Kidney Disease
Malyka Batool1, Qasim Javed2,3, Ali Shakeel4
1Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK.
Insights
Sacubitril/valsartan improved heart failure symptoms and cardiac function in patients with coexisting chronic kidney disease. However, renal function slightly declined, and hospitalizations increased, necessitating careful monitoring.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, complicating patient management.
- Therapeutic options for patients with both conditions are limited, especially those with impaired renal function.
- Understanding the impact of novel therapies on both cardiac and renal parameters is crucial.
Purpose of the Study:
- To assess the effects of sacubitril/valsartan on functional status, left ventricular ejection fraction (LVEF), and hospitalization rates in patients with heart failure with reduced ejection fraction (HFrEF) and CKD.
- To monitor the trajectory of renal function (eGFR) in this patient population during treatment with sacubitril/valsartan.
- To evaluate the safety and efficacy of sacubitril/valsartan in a real-world clinical setting for HFrEF patients with CKD.
Main Methods:
- Prospective observational study involving 194 adult HFrEF patients with CKD (eGFR: 15-60 mL/min/1.73 m²) initiated on sacubitril/valsartan.
- Patients were followed for 24 months with assessments of NYHA functional class, LVEF, eGFR, and HF-related hospitalizations.
- Data analysis focused on changes in clinical parameters and renal function over the follow-up period.
Main Results:
- Significant improvement in New York Heart Association (NYHA) functional class, with 52.6% of patients moving to Classes I-II.
- Mean left ventricular ejection fraction (LVEF) increased from 32.5% to 35.2%.
- A modest but statistically significant decline in mean estimated glomerular filtration rate (eGFR) from 39.2 to 37.4 mL/min/1.73 m² was observed.
- 35.1% of patients experienced one or more heart failure-related hospitalizations during the 24-month follow-up.
Conclusions:
- Sacubitril/valsartan demonstrated benefits in functional status and cardiac performance for HFrEF patients with CKD.
- A trend towards declining renal function and an increase in hospitalizations were noted, highlighting the need for careful management.
- Individualized therapy, precise diuretic management, and close renal monitoring are essential for long-term angiotensin receptor-neprilysin inhibitor (ARNI) use in this complex patient group.
Abstract:
Introduction Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, posing significant management challenges due to overlapping pathophysiology and therapeutic limitations, particularly in patients with impaired renal function. The objective of this study is to assess how sacubitril/valsartan improves functional status, left ventricular ejection fraction (LVEF), and hospitalization rates in clinical settings while also tracking the trajectories of renal function in patients suffering from heart failure with reduced ejection fraction (HFrEF) and coexisting CKD. Methodology This prospective observational study was conducted from January 2023 to December 2024 at the Department of Cardiology, Gujranwala Medical College (GMC) (constituent college of the University of Health Sciences {UHS}, Lahore), Gujranwala Teaching Hospital, Pakistan. A total of 194 adult HFrEF patients with CKD (estimated glomerular filtration rate {eGFR}: 15-60 mL/minute/1.73 m²) who were initiated on sacubitril/valsartan were enrolled. Patients were followed for 24 months, with periodic assessments of New York Heart Association (NYHA) functional class, LVEF, estimated glomerular filtration rate (eGFR), and heart failure-related hospitalizations. Results By 24 months, 102 patients (52.6%) had improved to NYHA Classes I-II from 66 (34.0%) at baseline, while only 26 (13.4%) remained in Classes III-IV (p < 0.05). The mean LVEF improved from 32.5% ± 6.7% to 35.2% ± 6.3% (p < 0.05). Renal function showed a modest but statistically significant decline, with mean eGFR decreasing from 39.2 ± 9.6 to 37.4 ± 10.2 mL/minute/1.73 m² (p < 0.05). A total of 68 patients (35.1%) required one or more HF-related hospitalizations during follow-up, reflecting a gradual rise in admissions (p < 0.05). Conclusion In this cohort of HFrEF patients with CKD, sacubitril/valsartan was associated with improvements in functional status and cardiac performance. However, a modest decline in renal function and a progressive increase in hospitalizations were observed over time, underscoring the need for individualized therapy, careful diuretic titration, and close renal monitoring during long-term angiotensin receptor-neprilysin inhibitor (ARNI) use.
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