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. 2024 Dec;28(12):1327-1331.
doi: 10.1007/s10157-024-02561-z. Epub 2024 Oct 3.

Sacubitril/valsartan reduces proteinuria depending on blood pressure in patients with stage 4-5 chronic kidney disease

Yosuke Saka  1 , Hiroshi Takahashi  2 , Tomohiko Naruse  3 , Yuzo Watanabe  3
Affiliations

Sacubitril/valsartan reduces proteinuria depending on blood pressure in patients with stage 4-5 chronic kidney disease

Yosuke Saka et al. Clin Exp Nephrol. 2024 Dec.

Abstract

Background: Blood pressure (BP) control is an important factor in the management of chronic kidney disease (CKD). Several studies have shown that BP in many patients with CKD remained uncontrolled even with multiple medications. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), has been newly approved for treating hypertension in Japan. However, the renoprotective effects remain unclear, particularly in patients with advanced CKD. Here, we investigated the effects on proteinuria of this ARNI in patients with stage 4-5 CKD.

Methods: We retrospectively collected data from outpatients with stage 4-5 CKD who started ARNI from January until December 2023. The primary outcome was the change in urine protein creatinine ratio (UPCR) at 6 months after ARNI initiation. Secondary outcomes were systolic and diastolic BP, estimated glomerular filtration rate (eGFR), serum potassium, and serum uric acid (UA). We analyzed factors associated with 50% UPCR reduction by multivariate analysis.

Results: In total, 47 patients were analyzed. ARNI reduced UPCR from 2.14 g/gCr (interquartile range; 1.09-2.91) to 1.05 g/gCr (0.42-1.95; p < 0.001). Systolic BP fell from 150.0 mmHg (139.5-160.0) to 134.0 mmHg (124.5-140.0; p < 0.001). No significant changes in eGFR, serum potassium, and serum uric acid were observed, except for a slight decrease in eGFR among patients with conversion from a renin-angiotensin system inhibitor to ARNI. In multivariate regression analysis, higher systolic BP (per 10-mmHg increase) was significantly associated with reduced proteinuria (odds ratio 2.51, 95% confidence interval 1.35-4.66; p = 0.004).

Conclusions: ARNI reduced proteinuria in patients with stage 4-5 CKD, particularly for those with uncontrolled hypertension.

Keywords: Angiotensin receptor neprilysin inhibitor; Blood pressure; Proteinuria; Stage 4–5 CKD.

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Conflict of interest statement

Declarations. Conflict of interest: All authors declare no conflict of interest in relation to this manuscript. Human rights: All procedures involving human participants were performed following the ethical standards of the institutional and/or national research committee of the participating institutions and were performed per the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent: This was a retrospective observational study in which the study participants did not receive new interventions or invasive procedures. This study was performed according to the Ethical Guidelines for Medical and Health Research Involving Human Subjects established by the Ministry of Health, Labor, and Welfare (Japan) and the Institutional Review Board of Kasugai Municipal Hospital. The institutional review board of our hospital approved the study protocol (approval no. 558). All patients were informed that they had the right to withdraw from the study at any time.

References

    1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO. clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;2024(105):S117-314.
    1. Japanese Society of Nephrology. Essential points from evidence-based clinical practice guideline for chronic kidney disease 2023. Clin Exp Nephrol. 2024;28:473–95. - DOI - PMC
    1. Inaguma D, Imai E, Takeuchi A, et al. Risk factors for CKD progression in Japanese patients: findings from the Chronic Kidney Disease Japan Cohort (CKD-JAC) study. Clin Exp Nephrol. 2017;21:446–56. - DOI - PubMed
    1. Tsuchida-Nishiwaki M, Uchida HA, Takeuchi H, et al. Association of blood pressure and renal outcome in patients with chronic kidney disease; a post hoc analysis of FROM-J study. Sci Rep. 2021;11:14990. - DOI - PubMed - PMC
    1. Heerspink HJL, Holtkamp FA, Parving HH, et al. Moderation of dietary sodium potentiates the renal and cardiovascular protective effects of angiotensin receptor blockers. Kidney Int. 2012;82:330–7. - DOI

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