AUTHOR=Hsiao Fu-Chih , Lin Chia-Pin , Yu Chun-Chen , Tung Ying-Chang , Chu Pao-Hsien 

TITLE=Angiotensin Receptor-Neprilysin Inhibitors in Patients With Heart Failure With Reduced Ejection Fraction and Advanced Chronic Kidney Disease: A Retrospective Multi-Institutional Study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.794707

DOI=10.3389/fcvm.2022.794707

ISSN=2297-055X

ABSTRACT=Background
Data regarding using angiotensin receptor-neprilysin inhibitor (ARNI) in patients with both heartfailure with reduced ejection fraction (HFrEF) and advanced chronic kidney disease (CKD) are lacking.

Methods and Results
Between January 2016 and December 2018, patients with HFrEF and advanced CKD (estimated glomerular filtration rate [eGFR] ≤ 30 mL/min/1.73m2) were identified from a multi-institutional database in Taiwan. Patients who had never been prescribed with an ARNI, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) were excluded. We used inverse probability of treatment weighting (IPTW) to balance baseline covariates, and compared outcomes between ARNI and ACEI/ARB users.

There were 206 patients in the ARNI and 833 patients in the ACEI/ARB group. After IPTW adjustment, the mean ages (65.1 vs. 66.6 years), male patients (68.3% vs. 67.9%), left ventricular ejection fraction (30.5% vs.31.2%), eGFR (20.9 vs. 20.3 mL/min/1.73m2) were all comparable in the ARNI and ACEI/ARB groups. Over 85% of the patients had beta-blockers prescriptions in both groups (86.2% vs. 85.5%).

After IPTW adjustment, ARNI and ACEI/ARB users had a comparable risk of the composite clinical event (all-cause mortality or heart failure hospitalization) (hazard ratio [HR], 1.31; 95% confidence interval (CI) 0.91-1.88). In subgroup analysis, dialysis patients who used ARNIs were associated with higher incidence of heart failure hospitalization (subdistribution HR, 1.97; 95% CI 1.36-2.85).

Conclusions
ARNI was not associated with improved clinical outcomes in patients with HFrEF and advanced CKD. Dialysis patients who received ARNIs had a higher incidence of heart failure hospitalization.