Angiotensin Receptor–Neprilysin Inhibitor in Heart Failure Patients With Renal Dysfunction

IF 3.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Xiaogang Zhu, Xialing Li, Lingxuan Zhu, Zichuan Tong, Xiuying Xu
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引用次数: 0

Abstract

Heart failure (HF) and renal dysfunction often coexist and interact in many complex and bidirectional pathways, leading to detrimental effects on patient outcomes. The treatment of HF patients with renal dysfunction presents a significant clinical challenge. Interestingly, sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor (ARNI), may have beneficial effects on cardiac and renal outcomes in patients with HF with reduced ejection fraction, particularly by slowing the rate of decrease in the estimated glomerular filtration rate compared to a single angiotensin–converting enzyme inhibitor. Recently, more reports have emphasized the renal protection of sacubitril/valsartan in patients with HF. In HF patients with renal dysfunction, however, there is no strong evidence supporting the use of sacubitril/valsartan to reduce the absolute risk of hyperkalemia and worsening renal function; therefore, the administration of ARNI requires a careful balance between the benefits and risks. Furthermore, the lack of evidence-based management highlights the importance of an individualized approach based on published experience and multidisciplinary collaborations, as well as underlines the need for in-depth studies investigating the underlying mechanisms in cardiorenal interactions with a focus on treatments.

Abstract Image

肾功能不全心力衰竭患者的血管紧张素受体-奈普利酶抑制剂
心力衰竭(HF)和肾功能不全往往同时存在,并在许多复杂的双向途径中相互作用,从而对患者的预后产生不利影响。治疗肾功能不全的高血压患者是一项重大的临床挑战。有趣的是,与单一的血管紧张素转换酶抑制剂相比,血管紧张素受体-肾素抑制剂(ARNI)sacubitril/valsartan 可对射血分数降低的心房颤动患者的心脏和肾脏预后产生有益影响,尤其是可减缓估计肾小球滤过率的下降速度。最近,越来越多的报道强调了囊必利/缬沙坦对心房颤动患者肾脏的保护作用。然而,对于肾功能不全的心房颤动患者,尚无强有力的证据支持使用沙库比特利/缬沙坦来降低高钾血症和肾功能恶化的绝对风险;因此,在使用 ARNI 时需要谨慎权衡收益和风险。此外,循证管理的缺乏凸显了基于已发表经验和多学科合作的个体化方法的重要性,同时也强调了深入研究心肾相互作用内在机制的必要性,并将重点放在治疗上。
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来源期刊
Cardiovascular Therapeutics
Cardiovascular Therapeutics 医学-心血管系统
CiteScore
5.60
自引率
0.00%
发文量
55
审稿时长
6 months
期刊介绍: Cardiovascular Therapeutics (formerly Cardiovascular Drug Reviews) is a peer-reviewed, Open Access journal that publishes original research and review articles focusing on cardiovascular and clinical pharmacology, as well as clinical trials of new cardiovascular therapies. Articles on translational research, pharmacogenomics and personalized medicine, device, gene and cell therapies, and pharmacoepidemiology are also encouraged. Subject areas include (but are by no means limited to): Acute coronary syndrome Arrhythmias Atherosclerosis Basic cardiac electrophysiology Cardiac catheterization Cardiac remodeling Coagulation and thrombosis Diabetic cardiovascular disease Heart failure (systolic HF, HFrEF, diastolic HF, HFpEF) Hyperlipidemia Hypertension Ischemic heart disease Vascular biology Ventricular assist devices Molecular cardio-biology Myocardial regeneration Lipoprotein metabolism Radial artery access Percutaneous coronary intervention Transcatheter aortic and mitral valve replacement.
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