Abstract 4139457: The Efficacy of Sacubitril-Valsartan in Congestive Heart Failure Patients Who Also Have End Stage Renal Disease

Introduction: The PARADIGM-HF trial demonstrated that angiotensin receptor-neprilysin inhibitor was superior to enalapril in reducing risks of death and hospitalization for heart failure; however, the trial excluded patients with a GFR <30mL/min/1.73m2. This poses limited data when treating patients with concomitant congestive heart failure (CHF) and end-stage renal disease (ESRD). We observe the effects of sacubitril-valsartan on all-cause mortality, acute kidney injury (AKI), ventilation requirements, hyperkalemia, and intensive care unit (ICU) admissions in patients with both CHF and ESRD. Methods: We conducted a multicenter retrospective cohort on patients diagnosed with CHF and ESRD (defined as a GFR below <15mL/min/1.73m2) from 01/01/2017 to 06/01/2023 across 16 West Florida hospitals. Patients receiving sacubitril-valsartan were compared to those not taking sacubitril-valsartan. Chi-square and binary logistic regression were used to predict the clinical outcomes of all-cause mortality, AKI, ventilation requirements, hyperkalemia, and ICU admissions between the two groups. Results: Among 18,116 patients with CHF and ESRD, 712 (3.9%) were taking sacubitril-valsartan and 17,406 (96.1%) were not taking sacubitril-valsartan. Among those taking sacubitril-valsartan compared to those who were not, similar likelihood was seen in terms of all-cause mortality (OR 1.04, 95% CI 0.74-1.47; p=0.8325), hyperkalemia (OR 0.88, 95% CI 0.73-1.05; p=0.1464), and ICU admissions (OR 0.86, 95% CI 0.73-1.02; p=0.0825). The likelihood of AKI was higher in patients taking sacubitril-valsartan compared to those who were not (OR 1.20, 95% CI 1.02-1.43; p=0.0330). There was a significantly less likelihood of ventilation requirement among those taking sacubitril-valsartan compared to those who were not (OR 0.79, 95% CI 0.67-0.92; p=0.003). Conclusion: In patients with concomitant CHF and ESRD, the odds of all-cause mortality, hyperkalemia, and ICU admissions were similar among patients taking sacubitril-valsartan compared to those who were not. Patients taking sacubitril-valsartan were less likely to require ventilation but more likely to develop AKI. Although these patients are more likely to develop AKI, this does not significantly impact mortality rate. This study highlights outcomes excluded in the PARADIGM-HF trial.