Efficacy and safety of sacubitril-valsartan in hypertension patients with end-stage kidney disease on maintenance dialysis: a meta-analysis

The aim of this meta-analysis was to assess the efficacy and safety of sacubitril-valsartan in hypertension patients with end-stage kidney disease (ESKD) undergoing dialysis. We searched the Medline, Cochrane, Embase, Web of Science, and ClinicalTrials.gov databases for studies reporting outcomes after SV treatment. All analyses were performed utilizing the random effects models. Nineteen studies comprising 1597 patients with concomitant hypertension and ESKD undergoing dialysis were included. After sacubitril-valsartan treatment, significant reductions in both SBP and DBP were observed (mean change in SBP: -11.09 mmHg [95% confidence interval, 95% CI: -14.51,-7.66] and DBP: -4.37 mmHg [-6.36,-2.38]). Compared to conventional treatment, patients treated with sacubitril-valsartan had a lower risk of cardiovascular hospitalization (risk ratio: 0.63 [0.44,0.90]). Sacubitril-valsartan treatment showed a trend toward reducing the risk of all-cause mortality, although this was not statistically significant (risk ratio: 0.66 [0.27,1.60]). Evaluation of echocardiographic parameters among studies including hypertension patients with heart failure indicated that SV improved LVEF (mean change: +7.04%[+3.19, +10.90]), however this effect was more pronounced in the HFrEF patients ( Pinteraction =0.0003). Sacubitril-valsartan also reduced LVSd, LVDd, LAD, and E/e' ratio ( P < 0.05). The risks of severe hyperkalemia and symptomatic hypotension were comparable between sacubitril-valsartan treatment and conventional treatment ( P > 0.05). The present study revealed that sacubitril-valsartan treatment is well tolerated and could have potential benefits in hypertension patients with ESKD on dialysis by effectively controlling blood pressure, improving LVEF, reversing cardiac remodeling, and reducing the risk of cardiovascular hospitalization.