Efficacy and safety of angiotensin receptor–neprilysin inhibition in heart failure patients with end‐stage kidney disease on maintenance dialysis: A systematic review and meta‐analysis,European Journal of Heart Failure

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Efficacy and safety of angiotensin receptor–neprilysin inhibition in heart failure patients with end‐stage kidney disease on maintenance dialysis: A systematic review and meta‐analysis
European Journal of Heart Failure ( IF 16.9 ) Pub Date : 2024-09-10 , DOI: 10.1002/ejhf.3454
Dung Viet Nguyen ₁ , Thanh Ngoc Le ₂ , Binh Quang Truong ₃ , Hoai Thi Thu Nguyen _{1,

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Affiliation

AimsAngiotensin receptor–neprilysin inhibitor (ARNI) has played an increasingly important role in the management of heart failure (HF). However, the evidence on the benefits of ARNI in HF patients with end‐stage kidney disease (ESKD) undergoing dialysis is limited. This study aimed to investigate the efficacy and safety of ARNI in patients with concomitant HF and ESKD on maintenance dialysis.Methods and resultsWe systematically searched the MEDLINE, Embase, Web of Science, Cochrane, and ClinicalTrials.gov databases for studies reporting outcomes after ARNI treatment in HF patients with ESKD on dialysis. All meta‐analyses were performed using the random effects model. Twenty‐six studies comprising 2494 patients with concomitant HF and ESKD undergoing dialysis were included. Our synthesis showed a significant improvement in left ventricular ejection fraction (LVEF) between before and after ARNI treatment (mean change: 8.05%; 95% confidence interval [CI] 5.57–10.54). Compared to the conventional group, the ARNI group showed a greater improvement in LVEF (mean difference: 4.03%; 95% CI 2.90–5.16). This effect was more pronounced in patients with HF with reduced ejection fraction (pinteraction < 0.0001). Patients treated with ARNI had a lower risk of all‐cause mortality (risk ratio [RR] 0.64; 95% CI 0.45–0.92; p = 0.01) but had a similar rate of HF hospitalization (RR 0.71; 95% CI 0.43–1.18; p = 0.19). ARNI treatment showed benefits in the improvement of left ventricular end‐systolic diameter, left ventricular mass index, left atrial diameter, and E/e′ ratio (p < 0.05), while it did not significantly increase the risk of severe hyperkalaemia (p = 0.33) or symptomatic hypotension (p = 0.53).ConclusionThis meta‐analysis provided insights into the benefits of ARNI in HF patients with ESKD undergoing dialysis by improving left ventricular function, reversing left ventricular remodelling, and reducing the risk of all‐cause mortality, without increasing the risk of HF hospitalizations, severe hyperkalaemia, and symptomatic hypotension.

中文翻译：

血管紧张素受体-脑啡肽酶抑制对维持性透析的终末期肾病心力衰竭患者的疗效和安全性：系统评价和荟萃分析

目的血管紧张素受体-脑啡肽酶抑制剂（ARNI）在心力衰竭（HF）的治疗中发挥着越来越重要的作用。然而，关于 ARNI 对接受透析的终末期肾病 (ESKD) 心力衰竭患者的益处的证据有限。本研究旨在调查 ARNI 对同时存在 HF 和 ESKD 的维持性透析患者的有效性和安全性。方法和结果我们系统地检索了 MEDLINE、Embase、Web of Science、Cochrane 和 ClinicalTrials.gov 数据库，以获取报告 ARNI 治疗后结果的研究患有 ESKD 的透析心衰患者。所有荟萃分析均使用随机效应模型进行。纳入了 26 项研究，涉及 2494 名同时患有 HF 和 ESKD 并接受透析的患者。我们的综合结果显示，ARNI 治疗前后左心室射血分数 (LVEF) 显着改善（平均变化：8.05%；95% 置信区间 [CI] 5.57–10.54）。与传统组相比，ARNI 组的 LVEF 改善更大（平均差异：4.03%；95% CI 2.90-5.16）。这种效应在射血分数降低的心力衰竭患者中更为明显（pinteraction < 0.0001）。接受 ARNI 治疗的患者全因死亡风险较低（风险比 [RR] 0.64；95% CI 0.45–0.92；p = 0.01），但心衰住院率相似（RR 0.71；95% CI 0.43–1.18） p = 0.19）。 ARNI 治疗显示出改善左心室收缩末期内径、左心室质量指数、左心房直径和 E/e' 比值 (p < 0.05) 的益处，同时并没有显着增加严重高钾血症的风险 (p = 0.33）或症状性低血压（p = 0.53）。结论这项荟萃分析深入了解了 ARNI 对接受透析的心力衰竭 ESKD 患者的益处，即改善左心室功能、逆转左心室重构、降低全因死亡风险，而不增加心力衰竭住院、严重高钾血症、和症状性低血压。

更新日期：2024-09-10

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