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Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials

A worsening renal function is prevalent among patients with cardiovascular disease, especially heart failure (HF). Sacubitril/valsartan appears to prevent worsening of renal function and progression of chronic kidney disease (CKD) as compared with renin–angiotensin system (RAS) inhibitors alone in H...

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Autores principales: Spannella, Francesco, Giulietti, Federico, Filipponi, Andrea, Sarzani, Riccardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754726/
https://www.ncbi.nlm.nih.gov/pubmed/32960491
http://dx.doi.org/10.1002/ehf2.13002
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author Spannella, Francesco
Giulietti, Federico
Filipponi, Andrea
Sarzani, Riccardo
author_facet Spannella, Francesco
Giulietti, Federico
Filipponi, Andrea
Sarzani, Riccardo
author_sort Spannella, Francesco
collection PubMed
description A worsening renal function is prevalent among patients with cardiovascular disease, especially heart failure (HF). Sacubitril/valsartan appears to prevent worsening of renal function and progression of chronic kidney disease (CKD) as compared with renin–angiotensin system (RAS) inhibitors alone in HF patients. It is unclear whether these advantages are present in HF patients only, or can be extended to other categories of patients, in which this drug was studied. We performed a systematic review and meta‐analysis to assess the consistency of effect size regarding renal outcome across randomized controlled trials (RCTs) that compared sacubitril/valsartan with RAS inhibitors in patients with or without HF. We searched Medline (PubMed), Scopus, and Thomson Reuters Web of Science databases until June 2020. We took into account RCTs that compared sacubitril/valsartan with a RAS inhibitor and reported data regarding renal function. We used random‐effects models to obtain summary odds ratio (OR) with 95% confidence interval (CI). We extracted hazard ratios for renal outcomes, glomerular filtration rate slopes or rates of renal adverse events. Sensitivity analyses were performed by moderator analysis and random‐effects meta‐regression. The search revealed 10 RCTs (published between 2012 and 2019) on 16 456 subjects. Sacubitril/valsartan resulted in a lower risk of renal dysfunction as compared with RAS inhibitors alone [k = 10; pooled OR = 0.70 (95% CI 0.57–0.85); P < 0.001], with a moderate inconsistency between studies [Q(9) = 15.18; P = 0.086; I (2) = 40.73%]. A stronger association was found in studies including older patients (k = 10; β = −0.047730; P = 0.020) or HF patients with preserved ejection fraction [pooled OR = 0.53 (0.41–0.68) vs. 0.76 (0.57–1.01) for studies on HF patients with reduced ejection fraction; P for comparison = 0.065]. The effect size did not change with different comparators (angiotensin‐converting enzyme inhibitors vs. angiotensin II type 1 receptor blockers, P = 0.279). No significant association was found when the analysis was restricted to studies on non‐HF patients [k = 3; pooled OR = 0.86 (0.61–1.22); P = 0.403] and studies with high risk of bias [k = 3; pooled OR = 0.34 (0.08–1.44); P = 0.143]. Our findings support the role of sacubitril/valsartan on preservation of renal function, especially in older patients and HF patients with preserved ejection fraction. However, evidence is currently limited to HF patients, while the renal outcome of sacubitril/valsartan therapy outside the HF setting needs to be further investigated.
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spelling pubmed-77547262020-12-23 Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials Spannella, Francesco Giulietti, Federico Filipponi, Andrea Sarzani, Riccardo ESC Heart Fail Reviews A worsening renal function is prevalent among patients with cardiovascular disease, especially heart failure (HF). Sacubitril/valsartan appears to prevent worsening of renal function and progression of chronic kidney disease (CKD) as compared with renin–angiotensin system (RAS) inhibitors alone in HF patients. It is unclear whether these advantages are present in HF patients only, or can be extended to other categories of patients, in which this drug was studied. We performed a systematic review and meta‐analysis to assess the consistency of effect size regarding renal outcome across randomized controlled trials (RCTs) that compared sacubitril/valsartan with RAS inhibitors in patients with or without HF. We searched Medline (PubMed), Scopus, and Thomson Reuters Web of Science databases until June 2020. We took into account RCTs that compared sacubitril/valsartan with a RAS inhibitor and reported data regarding renal function. We used random‐effects models to obtain summary odds ratio (OR) with 95% confidence interval (CI). We extracted hazard ratios for renal outcomes, glomerular filtration rate slopes or rates of renal adverse events. Sensitivity analyses were performed by moderator analysis and random‐effects meta‐regression. The search revealed 10 RCTs (published between 2012 and 2019) on 16 456 subjects. Sacubitril/valsartan resulted in a lower risk of renal dysfunction as compared with RAS inhibitors alone [k = 10; pooled OR = 0.70 (95% CI 0.57–0.85); P < 0.001], with a moderate inconsistency between studies [Q(9) = 15.18; P = 0.086; I (2) = 40.73%]. A stronger association was found in studies including older patients (k = 10; β = −0.047730; P = 0.020) or HF patients with preserved ejection fraction [pooled OR = 0.53 (0.41–0.68) vs. 0.76 (0.57–1.01) for studies on HF patients with reduced ejection fraction; P for comparison = 0.065]. The effect size did not change with different comparators (angiotensin‐converting enzyme inhibitors vs. angiotensin II type 1 receptor blockers, P = 0.279). No significant association was found when the analysis was restricted to studies on non‐HF patients [k = 3; pooled OR = 0.86 (0.61–1.22); P = 0.403] and studies with high risk of bias [k = 3; pooled OR = 0.34 (0.08–1.44); P = 0.143]. Our findings support the role of sacubitril/valsartan on preservation of renal function, especially in older patients and HF patients with preserved ejection fraction. However, evidence is currently limited to HF patients, while the renal outcome of sacubitril/valsartan therapy outside the HF setting needs to be further investigated. John Wiley and Sons Inc. 2020-09-22 /pmc/articles/PMC7754726/ /pubmed/32960491 http://dx.doi.org/10.1002/ehf2.13002 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Reviews
Spannella, Francesco
Giulietti, Federico
Filipponi, Andrea
Sarzani, Riccardo
Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials
title Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials
title_full Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials
title_fullStr Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials
title_full_unstemmed Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials
title_short Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials
title_sort effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754726/
https://www.ncbi.nlm.nih.gov/pubmed/32960491
http://dx.doi.org/10.1002/ehf2.13002
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