Sacubitril/Valsartan Could Slow Decline of Renal Function in HFpEF

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Muthiah Vaduganathan, MD, MPH, discusses the results of a study examining the effects of sacubitril/valsartan against valsartan alone on kidney outcomes among patients with HFpEF in the PARAGON-HF trial.

Data from an analysis of the PARAGON-HF trial provides insight into the effects of sacubitril/valsartan (Entresto) on renal outcomes among patients with type 2 diabetes and heart failure with preserved ejection fraction (HFpEF).

Presented at the American College of Cardiology 71st Annual Scientific Sessions, data from the analysis detail the effects of sacubitril/valsartan use on decline of eGFR and risk of adverse kidney events compared against valsartan alone in the phase 3 trial.

Since receiving approval from the FDA for use in patients with an ejection fraction below normal, sacubitril/valsartan has been finding its role in management of heart failure across a wider spectrum of ejection fractions. With an interest in further assessing the defects of sacubitril/valsartan use compared against valsartan alone in patients with HFpEF, the prespecified analysis was designed to examine the effects of use on renal function among these patients in the PARAGON-HF trial.

A cohort of 4796 patients enrolled in PARAGON-HF had an ejection fraction of 45% or greater. Outcomes of interest for the analysis included change in eGFR over the study period and incidence of a respecified renal outcome, which was defined as an eGFR reduction of 50% or more, end-stage renal disease, or death attributable to renal causes in those with and without type 2 diabetes.

The investigators’ analysis indicated the decline in eGFR observed in the study was greater in patients with type 2 diabetes compared to those without. Results also suggested use of sacubitril/valsartan was associated withan attenuated decline in eGFR in patients with and without type 2 diabetes (P for difference in slopes=.40). When compared against valsartan use, use of sacubitril/valsartan was associated with a reduction in risk of experiencing an event within the prespecified renal composite outcome in patients with type 2 diabetes (HR, 0.42 [95% CI, 0.19-0.91]), without (HR, 0.54 [95% CI, 0.33-0.89]) type 2 diabetes (P for interaction=.59), and across the spectrum of baseline HbA1c (P for interaction =.71).

For further insight into how these results inform use of sacubitril/valsartan Practical Cardiology reached out to study investigator and Don’t Miss a Beat co-host Muthiah Vaduganathan, MD, MPH, and that conversation can be found below.

This study, “Effects of Sacubitril/Valsartan versus Valsartan on Renal Function in Patients with Type 2 Diabetes and Heart Failure with Preserved Ejection Fraction: PARAGON-HF,” was presented at ACC.22.