Effect of angiotensin receptor neprilysin inhibitor in patients of heart failure with reduced ejection fraction with reduced ejection fraction with cardiorenal syndrome type-1
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20222740Keywords:
Heart failure, ARNI, Cardiorenal syndrome, Reduced ejection fraction, ACEIAbstract
Background: Heart failure is recognized as one of the most common indications for hospitalization. The dysfunction of either the heart or the kidneys affect the functioning of each other and thus play an important role in the quality of life.
Methods: This study is a Prospective interventional Cohort study over a period of 18 months in 125 patients. The patients were divided into two broad treatment groups. The primary end point of the study was to quantify the response of ARNI for renal recovery in patients of cardio-renal syndrome and improvement in cardiovascular parameters by measuring the change in urine output, estimated glomerular filtration rate, serum creatinine, change in weight of the patients, control of blood pressure and change in left ventricular ejection fraction. The secondary end-points were evaluated during the 60 days follow up period post admissions.
Results: Cardio-renal syndrome was seen in 39% of the patients. On screening e-GFR was 91±14 and 49±8 for group 1and 2 respectively, the median age, UACR was 59 years ,1.0 mg/mmol respectively for both the groups and 19% had micro albuminuria. ACEIs had more reports of hyperkalemia (8/32, 25%), and greater deterioration of renal parameters (10/32, 34%) needing discontinuation of the drug in some patients. Patients also developed cough (6/32, 20%) needing replacement with ARBs. ARNI group developed more hypotension (6/31, 20%). In all cardiovascular and renal end points except UACR, ARNI showed better recovery profile in CRS-1patients including diabetics.
Conclusions: This study showed beneficial effects of ARNI in heart failure patients with cardio-renal syndrome.
References
Moulin B. Cardiorenal syndromes: definition and classification. Rev Prat. 2016;66(6):608-10.
Obi Y, Kim T, Kovesdy CP, Amin AN, Kalantar-Zadeh K. Current and potential therapeutic strategies for hemodynamic cardiorenal syndrome. Cardiorenal Med. 2016;6(2):83-98.
Mc Alister FA, Ezekowitz J, Tonelli M, Armstrong PW. Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation. 2004;109:1004-9.
HOPE Investigators. Effects of an angiotensin-converting enzyme-inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145-53.
The acute infarction ramipril efficacy study investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993; 342:821-8.
Braunwald E. The path to an angiotensin receptor antagonist –neprilysin inhibitor in the treatment of heart failure. J Am Coll Cardiol. 2015;65:1029-41.
Waldum-Grevbo B. What physicians need to know about renal function in outpatients with heart failure. Cardiology. 2015;131:130-8.
Yu Feng, Yongmei Y, Rong D, Haonan L. Renal safety and efficacy of angiotensin receptor-neprilysin inhibitor: A meta-analysis of randomized controlled trials. J Clin Pharm Therap. 2020;45(6):1235-43.
Scott AH, Brown NJ. Combined angiotensin receptor antagonism and neprilysin inhibition. Circulation. 2016;133:1115-24.
Voors AA, Gori M, Lin L. Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with HF and preserved ejection fraction. Eur J Heart Failure. 2015;17:510-7
Packer M, Califf RM, Konstan MA. Comparison of omapatrilat and enalapril in patients with chronic heart failure: the omapatrilat Vs Enalapril. Circulation. 2002;106:920-6.
Rouleau JL, Pfeffer MA, Stewart DJ. Comparison of vasopeptidase inhibitor, omapatrilat and lisinopril on exercise tolerance morbidity in patients with heart failure: IMPRESS randomize trial. Lancet. 2000;356: 615-20.
O’Connell JC, Jardin AG, Davies DL, MCQueen J, Connell JM. Renal and hormonal effects of chromosomal inhibition of neutral endopeptidase in normal man. Clin Sci. 1993;85:19-26.
Taal MW, Nenov VD, Wong W. Vasopeptidase inhibitor affords greater renoprotection than ACE inhibition alone. J AM Soc Nephrol. 2001;12:2051-9.
Mcmurray J, Seidelin PH, Howey JE, Balfour DJ, Struthens AD. The effect of ANP on urinary albumin and B2 microglobulin excretion in man. J Hypertension. 1988;6:783-6.