Angiotensin-neprilysin inhibition and renal outcomes across the spectrum of ejection fraction in heart failure.
Angiotensin-neprilysin inhibition and renal outcomes across the spectrum of ejection fraction in heart failure.
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DOI：
10.1002/ejhf.2421
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发表时间：
2022-09
影响因子：
18.2
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
--
作者：
Mc Causland, Finnian R.;Lefkowitz, Martin P.;Claggett, Brian;Packer, Milton;Senni, Michele;Gori, Mauro;Jhund, Pardeep S.;McGrath, Martina M.;Rouleau, Jean L.;Shi, Victor;Swedberg, Karl;Vaduganathan, Muthiah;Zannad, Faiez;Pfeffer, Marc A.;Zile, Michael;McMurray, John J., V;Solomon, Scott D.
无论射血分数（EF）如何，心力衰竭患者进展为终末期肾病（ESRD）的风险较高。我们在对13，195名EF降低和保留的心力衰竭患者的汇总分析中评估了血管紧张素/脑啡肽酶抑制对肾脏的影响。我们将PARADIGM-HF（LVEF ≤40%; n= 8，399）和PARAGON-HF（LVEF ≥45%; n= 4，796）的数据合并在预先规定的汇总分析中。我们评估了治疗（沙库巴曲/缬沙坦与依那普利或缬沙坦）对eGFR降低≥50%、ESRD或肾源性死亡以及eGFR斜率变化的复合效应。我们评估了基线肾功能或EF是否改变了治疗对肾脏结局的影响。随机化时，PARADIGM-HF组的eGFR为68±20 ml/min/1.73m2，PARAGON-HF组为63±19 ml/min/1.73m2。沙库巴曲/缬沙坦组6594例患者中有70例（1.1%）发生复合肾脏结局，缬沙坦或依那普利组6601例患者中有123例（1.9%）发生复合肾脏结局（HR 0.56，95%CI 0.42-0.75; P<0.001）。沙库巴曲/缬沙坦组的平均eGFR变化为−1.8（95%CI −1.9至−1.7）ml/min/1.73 m2/年，而缬沙坦或依那普利组为−2.4（95%CI −2.5至−2.2）ml/min/1.73 m2/年。对复合肾脏终点的治疗效应未因基线eGFR类别而改变（P-相互作用= 0. 64），但在基线EF介于30-60%之间的患者中最为显著（P-相互作用= 0. 001）。在心力衰竭患者中，沙库巴曲/缬沙坦与缬沙坦或依那普利相比降低了严重不良肾脏结局的风险，并减缓了eGFR的下降，与基线肾功能无关。
Patients with heart failure are at higher risk of progression to end-stage renal disease (ESRD), regardless of ejection fraction (EF). We assessed the renal effects of angiotensin/neprilysin inhibition in a pooled anlaysis of 13,195 patients with heart failure with reduced and preserved EF. We combined data from PARADIGM-HF (LVEF ≤40%; n=8,399) and PARAGON-HF (LVEF ≥45%; n=4,796) in a prespecified pooled analysis. We assessed the effect of treatment (sacubitril/valsartan vs. enalapril or valsartan) on a composite of either ≥50% reduction in eGFR, ESRD, or death from renal causes, in addition to changes in eGFR slope. We assessed whether baseline renal function or EF modified the effect of therapy on renal outcomes. At randomization, eGFR was 68±20 ml/min/1.73m2 in PARADIGM-HF and 63±19 ml/min/1.73m2 in PARAGON-HF. The composite renal outcome occurred in 70 of 6594 patients (1.1%) in the sacubitril/valsartan group and 123 of 6601 patients (1.9%) in the valsartan or enalapril group (HR 0.56, 95%CI 0.42–0.75; P<0.001). The mean eGFR change was −1.8 (95%CI −1.9 to −1.7) ml/min/1.73m2/year for the sacubitril/valsartan group, compared with −2.4 (95%CI −2.5 to −2.2) ml/min/1.73m2/year for the valsartan or enalapril group. The treatment effect on the composite renal endpoint was not modified by categories of baseline eGFR (P-interaction=0.64), but was most pronounced in those with baseline EF between 30–60% (P-interaction=0.001). In patients with heart failure, sacubitril/valsartan reduced the risk of serious adverse renal outcomes, and slowed decline in eGFR, compared with valsartan or enalapril, independent of baseline renal function.
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作者：
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