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. 2021 Feb 15;5(2):286-297.
doi: 10.1016/j.mayocpiqo.2020.10.008. eCollection 2021 Apr.

Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker

Nicholas Y Tan  1 , Yihong Deng  2 , Xiaoxi Yao  1   2   3 , Lindsey R Sangaralingham  2 , Nilay D Shah  2   3   4 , Andrew D Rule  5 , John C Burnett Jr  1   6 , Shannon M Dunlay  1   3 , S Jeson Sangaralingham  1   6
Affiliations

Renal Outcomes in Patients with Systolic Heart Failure Treated With Sacubitril-Valsartan or Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker

Nicholas Y Tan et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To assess 4 adverse renal outcomes in a heterogeneous cohort of patients with systolic heart failure (HF) who were prescribed sacubitril-valsartan vs angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB).

Patients and methods: The OptumLabs Database Warehouse, which contains linked administrative claims and laboratory results, was used to identify patients with systolic HF who were prescribed sacubitril-valsartan or ACEi/ARB between July 1, 2015, and September 30, 2019. One-to-one propensity score matching and inverse probability of treatment weighting was used to balance baseline variables. Cox proportional hazards modeling was performed to compare renal outcomes in both medication groups, including 30% or more decline in estimated glomerular filtration rate (eGFR), doubling of serum creatinine, acute kidney injury (AKI), and kidney failure (eGFR < 15 mL/min per 1.73 m2, kidney transplant, or dialysis initiation).

Results: A total of 4667 matched pairs receiving sacubitril-valsartan or ACEi/ARB were included; the mean follow-up period was 7.8±7.8 months. The mean age was 69.4±11 years; 35% were female, 19% black, and 15% Hispanic. The cumulative risk at 1 year was 6% for 30% or more decline in eGFR, 2% for doubling of serum creatinine, 3% for AKI, and 2% to 3% for kidney failure. Furthermore, no significant differences in risk were observed with sacubitril-valsartan compared with ACEi/ARB for a 30% or more decline in eGFR (hazard ratio [HR], 0.96; 95% CI, 0.79 to 1.10), doubling of serum creatinine (HR, 0.94; 95% CI, 0.69 to 1.27); AKI (HR, 0.80; 95% CI, 0.63 to 1.03), and kidney failure (HR 0.80; 95% CI, 0.59 to 1.08).

Conclusion: Among patients with systolic HF, the risk of adverse renal outcomes was similar between patients prescribed sacubitril-valsartan and those prescribed ACEi/ARB.

Keywords: ACEi, angiotensin-converting enzyme inhibitor; AKI, acute kidney injury; ARB, angiotensin receptor blocker; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; HR, hazard ratio; ICD-10, International Classification of Diseases, Tenth Revision; ICD-9, International Classification of Diseases, Ninth Revision; IPTW, inverse probability of treatment weighting; NP, natriuretic peptide; RAAS, renin-angiotensin-aldosterone system; RCT, randomized controlled trial; eGFR, estimated glomerular filtration rate.

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Figures

Figure 1
Figure 1
Comparative cumulative risk curves for (A) 30% or more decline in estimated glomerular filtration rate, (B) doubling of serum creatinine, (C) acute kidney injury, and (D) kidney failure in patients on sacubitril-valsartan or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB).
Figure 2
Figure 2
Differences in the risk of (A) 30% or more decline in estimated glomerular filtration rate (eGFR) and (B) doubling of serum creatinine according to patient baseline characteristics. ACEi/ARB = angiotensin-converting enzyme inhibitor/angiotensin receptor blocker; HR = hazard ratio.
Figure 3
Figure 3
Differences in the risk of (A) acute kidney injury and (B) kidney failure according to patient baseline characteristics. ACEi/ARB = angiotensin-converting enzyme inhibitor/angiotensin receptor blocker; eGFR = estimated glomerular filtration rate; HR = hazard ratio.
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