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Effect of Angiotensin-Neprilysin Versus Renin-Angiotensin System Inhibition on Renal Outcomes: A Systematic Review and Meta-Analysis.

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机构： [1]The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, [2]The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia, [3]The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China, [4]Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China, [5]National Key Clinical Department of Kidney Diseases, Institute of Nephrology, Zhejiang University, Hangzhou, China, [6]The Faculty of Medicine, Bond University, Gold Coast, QLD, Australia, [7]Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China, [8]The Department of Renal Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia, [9]Concord Clinical School, The University of Sydney, Sydney, NSW, Australia

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关键词： sacubitril/valsartan renin–angiotensin–aldosterone system renal outcomes systematic review metaanalysis

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Aims: We aim to perform a systematic review and meta-analysis examining randomized controlled trials assessing the efficacy and safety of sacubitril/valsartan in patients on renal outcomes, in comparison with the renin-angiotensin-aldosterone system inhibitor (RAASi). Methods: Eligible studies were retrieved on MEDLINE, EMBASE, and Cochrane until September 2021. The primary outcome was the incidence of renal impairment, which was defined as the composite of increases in serum creatinine by >0.3 mg/dl and/or a reduction in eGFR ≥25%, development of ESRD, or renal death. We pooled relative risks (RRs) with 95% confidence intervals (CIs) or the mean difference with 95% CIs for the variables. Results: Our search yielded 10 randomized controlled trials with a total of 18,362 patients. Compared with RAASi treatment, patients treated with sacubitril/valsartan had lower incidence of composite renal impairment (10 studies, 18,362 patients, RR 0.84; 95% CI 0.72-0.96, p = 0.01; I 2 = 22%), ESRD development (3 studies, 13,609 patients, RR 0.53; 95% CI 0.30-0.96, p = 0.03; I 2 = 0%), drug discontinuation due to renal events (4 studies, 9,995 patients, RR 0.58; 95% CI 0.40-0.83, p = 0.003; I 2 = 47%), severe hyperkalemia (6 studies, 16,653 patients, RR 0.80; 95% CI 0.68-0.93, p = 0.01; I 2 = 25%) and a slower eGFR decline (4 studies, 13,608 patients, WMD 0.56; 95% CI 0.36-0.76, p < 0.00001; I 2 = 65%). Subgroup analysis demonstrated that sacubitril/valsartan was associated with a lower incidence of renal impairment in patients with heart failure and preserved ejection fraction (HFpEF), but not in those with heart failure and reduced ejection fraction (HFrEF). The superior renal function preservation of sacubitril/valsartan treatment was not associated with different baseline eGFR levels and follow-up duration. There was a smaller increase in the change in the urine albumin-to-creatinine ratio (UACR) (3 studies, 9,114 patients, SMD 0.06; 95% CI 0.02-0.10, p = 0.003; I 2 = 14%) with sacubitril/valsartan treatment. However, patients with heart failure appeared to have increased microalbuminuria, not patients without HF (p = 0.80 for interaction). Conclusion: Sacubitril/valsartan was associated with a lower incidence of composite renal impairment especially in patients with HFpEF, but higher microalbuminuria in patients with heart failure (both HFrEF and HFpEF) compared with RAASi. The lower incidence of severe hyperkalemia and drug discontinuation due to renal events in patients with sacubitril/valsartan treatment demonstrated its superior safety compared with RAASi.Copyright © 2021 Xu, Chen, Zhao, Li and Wang.

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出版当年[2020]版：

大类 | 2 区医学

小类 | 2 区药学

最新[2023]版：

大类 | 2 区医学

小类 | 2 区药学

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出版当年[2019]版：

Q1 PHARMACOLOGY & PHARMACY

最新[2023]版：

Q1 PHARMACOLOGY & PHARMACY

影响因子： 4.4 最新[2023版] 5 最新五年平均 4.225 出版当年[2019版] 4.604 出版当年五年平均 3.845 出版前一年[2018版] 5.811 出版后一年[2020版]

第一作者：

第一作者机构： [1]The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, [2]The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia, [3]The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China, [4]Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China, [5]National Key Clinical Department of Kidney Diseases, Institute of Nephrology, Zhejiang University, Hangzhou, China,

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通讯作者：

通讯机构： [1]The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, [2]The Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia, [3]The Third Grade Laboratory Under the National State, Administration of Traditional Chinese Medicine, Hangzhou, China, [4]Key Laboratory of Kidney Disease Prevention and Control Technology, Hangzhou, China, [5]National Key Clinical Department of Kidney Diseases, Institute of Nephrology, Zhejiang University, Hangzhou, China, [8]The Department of Renal Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia, [9]Concord Clinical School, The University of Sydney, Sydney, NSW, Australia

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Effect of Angiotensin-Neprilysin Versus Renin-Angiotensin System Inhibition on Renal Outcomes: A Systematic Review and Meta-Analysis.

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