Combination therapy with sacubitril and valsartan reduces mortality and the hospitalization rate in patients with heart failure and reduced ejection fraction (HFrEF) receiving dialysis for kidney failure, suggests a report in JAMA Network Open.
The retrospective study included propensity-matched groups of Medicare-enrolled patients with HFrEF and kidney failure who were on dialysis: 1434 receiving sacubitril-valsartan and 1434 receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Approximately two-thirds of patients were male, one-third were Black, and more than half were White; the median time on dialysis was 3.8 years. Primary outcomes of all-cause mortality, cardiovascular mortality, all-cause hospitalization, and heart failure hospitalization were compared at a median follow-up of 0.9 years.
Overall mortality was 39% in patients receiving sacubitril-valsartan versus 43% in those with angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy. On a propensity score-matched analysis, sacubitril-valsartan was associated with significant reductions in all-cause mortality (hazard ratio [HR], 0.82) and all-cause hospitalization (HR, 0.86). Cardiovascular mortality and the heart failure hospitalization rate were similar between groups. As-treated and subgroup analyses showed a comparable pattern. Sacubitril-valsartan was associated with a lower risk of hyperkalemia (HR, 0.71), with no significant difference in hypertension. Only 14% of patients received the maximum dose of sacubitril-valsartan at any time during the study.
Previous trials have reported reductions in mortality and hospitalization with sacubitril-valsartan for patients with HFrEF. The recent study extends these findings to suggest improved all-cause mortality and hospitalization rates with sacubitril-valsartan in patients with HFrEF on dialysis. The researchers conclude: “[S]acubitril-valsartan may have significant therapeutic potential among patients with HFrEF requiring hemodialysis, but further studies are needed before changes in clinical practice” [Le D, et al. Sacubitril-valsartan in patients requiring hemodialysis. JAMA Netw Open 2024; 7:e2429237. doi: 10.1001/jamanetworkopen.2024.29237].
