Sacubitril/Valsartan Improves Glycoalbumin in Patients with Diabetes on Hemodialysis: Potential Metabolic Benefit of Angiotensin Receptor-Neprilysin Inhibition

Background: Sacubitril/valsartan (Entresto), an angiotensin receptor–neprilysin inhibitor (ARNI), is known for its cardioprotective and antihypertensive effects. Recent findings suggest it may also preserve DPP-4–sensitive peptides, potentially improving insulin sensitivity. However, its metabolic impact has not been evaluated in hemodialysis patients. In this population, glycoalbumin (GA) is a more reliable glycemic marker than HbA1c. Methods: In this retrospective observational study, we included 9 maintenance hemodialysis patients with type 2 diabetes mellitus who received sacubitril/valsartan for ≥9 months without any changes in antidiabetic medications. GA levels, pre-dialysis blood pressure, and dry weight were assessed from 2 months before to 6 months after ARNI initiation. Statistical analysis was performed using the Friedman and Nemenyi tests. Results: ΧGA levels significantly decreased over time (Χ2= 24.16, p = 0.0022), with a moderate effect size (Kendall’s W = 0.33). Although post hoc comparisons did not reach significance, a consistent downward trend was observed. No adverse events were reported. Pre-dialysis blood pressure slightly improved, and dry weight remained stable. Conclusion: To our knowledge, this is the first report demonstrating improved glycemic control, as measured by GA, in diabetic hemodialysis patients treated with sacubitril/valsartan without altering antidiabetic therapy. These findings suggest that ARNI may offer a novel metabolic benefit in this high-risk population, beyond its established cardiovascular effects. Funding: Private Foundation Support