Effects of sacubitril valsartan on renal function in adults with heart failure: a systematic review and meta analysis of randomised controlled trials

Abstract Background Sacubitril/valsartan (S/V) may have beneficial effects on renal outcomes in patients with heart failure (HF) receiving angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Purpose To systematically evaluate the of sacubitril/valsartan function adults HF. Methods Five databases were searched for randomised controlled trials (RCTs) comparing S/V (LCZ696) vs. ACEI ARB adult HF until January 2022. Doubling serum creatinine levels was primary outcome. Acute kidney injury (AKI)>50% decline estimated glomerular filtration rate (eGFR), and hyperkalaemia (serum K+ >5.5 mmol/L) secondary outcomes. Inverse variance random-effects meta-analyses used, described relative risks (RR) their 95% confidence intervals (CI). Subgroup analyses by type (chronic acute), LVEF (<40% vs >40%) performed. We used RoB 2.0 tool risk bias assessments RCTs. GRADE methods to certainty evidence (CoE). Results Eight RCTs (n=15859) included; four chronic acute Mean age 66.2 (SD 5.5) years-old, 34.1% female. The median follow-up across 36 weeks. In comparison ACEI/ARB, associated lower doubling (RR 0.77; CI 0.72–0.83; I2=0%; moderate CoE). did not reduce AKI 0.88; 0.72–1.08; low CoE), >50% eGFR 0.65; 0.37–1.17; I2=45%; very 1.01; 0.81–1.25; I2=44%; Two had high two some concerns bias. consistent main Conclusions failure, reduced compared but AKI, hyperkalaemia. analyses. Funding Acknowledgement Type funding sources: None.