Effects of sacubitril/valsartan in patients with heart failure and chronic kidney disease: A meta-analysis

Sacubitril/valsartan (LCZ696) is recommended for ejection fraction reduction in heart failure. However, studies comparing the effects of sacubitril/valsartan in patients with heart failure and chronic kidney disease (CKD) with the inhibitor of renal angiotensin system (RAS) are limited. To further demonstrate the benefits of sacubitril/valsartan in patients with both heart failure and CKD, a meta-analysis of randomized controlled trials (RCTs) was conducted. The Cochrane Library, PubMed, Web of Science and ClinicalTrials.gov were searched for RCTs. A total of 3460 individuals with heart failure and CKD were included in this meta-analysis. Sacubitril/valsartan was compared with irbesartan, valsartan and enalapril. It was found that sacubitril/valsartan significantly increased estimated glomerular filtration rate [eGFR, MD = 1.90, 95% CI (0.30, 3.50), P = 0.02]. However, sacubitril/valsartan had no difference in urinary albumin/creatinine ratio [UACR, MD = -0.30, 95% CI (-1.38, 0.78), P = 0.59] compared to the control group. Sacubitril/valsartan showed dramatically decrease in systolic blood pressure [SBP, MD = -4.39, 95% CI (-6.11, -2.68), P < 0.001], diastolic blood pressure [DBP, MD = -2.69, 95% CI (-4.04, -1.35), P < 0.001], and N-terminal prohormone brain natriuretic peptide [NT-proBNP, MD = -45.34, 95% CI (-46.63, -44.06), P < 0.001]. There was no significant difference in the incidence of adverse reactions between sacubitril/valsartan and the control group. Compared with the RAS inhibitor, sacubitril/valsartan significantly increased eGFR and decreased BP and NT-proBNP, which indicates that it might have cardiovascular and renal benefits in patients with heart failure and CKD.