The impact of angiotensin-receptor neprilysin inhibitors on cardiovascular events and solute transport function in peritoneal dialysis patients: a multicenter retrospective controlled study.

IF 3 3区 医学 Q1 UROLOGY & NEPHROLOGY
Renal Failure Pub Date : 2024-12-01 Epub Date: 2024-11-28 DOI:10.1080/0886022X.2024.2431637
Yishu Wang, Canxin Zhou, Xiaoyan Ma, Yingfeng Shi, Xiujuan Zang, Shoujun Bai, Yan Hu, Zexin Lv, Haijuan Hong, Yakun Wang, Danying Yan, Xinyu Yang, Chao Yu, Daofang Jiang, Shougang Zhuang, Yi Wang, Na Liu
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引用次数: 0

Abstract

Background: Whether angiotensin receptor-neprilysin inhibitor (ARNI) can reduce the incidence of cardiovascular events and improve peritoneal function in peritoneal dialysis (PD) patients remains unclear. Thus, this study aims to clarify the role of ARNI in PD patients.

Methods: This was a multicenter retrospective study. A total of 102 patients were enrolled for analysis. Patients who continuously used ARNI for 12 months were assigned to the ARNI group (n = 55), while those who never used ARNI to the control group (n = 47). Clinical indicators and cardiovascular risk factors were analyzed, along with in vitro experiments on neoangiogenesis to investigate the underlying molecular mechanisms of peritoneal protection by ARNI.

Results: Systolic blood pressure (p = 0.001), diastolic blood pressure (p = 0.001), and left ventricular ejection fraction (p = 0.008) were statistically improved after 12 months of ARNI therapy, whereas these metrics did not change in control patients. The risk factors for the occurrence of cardiac events in PD patients included the use of ARNI [hazard ratio (HR) 0.053; 95% confidence interval (CI), 0.006-0.492] and NT-proBNP level (HR 2.317; 95% CI, 1.179-4.554). Additionally, there was a decrease in 4-hour ratio of creatinine concentration in dialysate to plasma (4h Scr D/P) in the ARNI group (p = 0.020). The in vitro experiments showed that LCZ696, a combination of sacubitril and valsartan, inhibited neoangiogenesis via the VEGFR2/ERK1/2 and Notch1 pathways.

Conclusions: ARNI may play a protective role in reducing the incidence of cardiovascular events and decreasing solute transport in PD patients.

血管紧张素受体奈普利素抑制剂对腹膜透析患者心血管事件和溶质转运功能的影响:一项多中心回顾性对照研究
背景:血管紧张素受体-奈普利素抑制剂(ARNI)是否能降低腹膜透析(PD)患者心血管事件的发生率和改善腹膜功能尚不清楚。因此,本研究旨在阐明ARNI在PD患者中的作用。方法:这是一项多中心回顾性研究。共纳入102例患者进行分析。连续使用ARNI 12个月的患者被分配到ARNI组(n = 55),而从未使用ARNI的患者被分配到对照组(n = 47)。通过分析临床指标和心血管危险因素,结合体外新生血管生成实验,探讨ARNI对腹膜保护的分子机制。结果:经过12个月的ARNI治疗后,收缩压(p = 0.001)、舒张压(p = 0.001)和左心室射血分数(p = 0.008)在统计学上有所改善,而对照组患者的这些指标没有变化。PD患者发生心脏事件的危险因素包括使用ARNI[危险比(HR) 0.053;95%可信区间(CI), 0.006-0.492]和NT-proBNP水平(HR 2.317;95% ci, 1.179-4.554)。此外,ARNI组透析液中4小时肌酐浓度与血浆的比值(4h Scr D/P)降低(P = 0.020)。体外实验表明,sacubitril和缬沙坦联用LCZ696通过VEGFR2/ERK1/2和Notch1途径抑制新生血管生成。结论:ARNI可能具有降低PD患者心血管事件发生率和降低溶质转运的保护作用。
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来源期刊
Renal Failure
Renal Failure 医学-泌尿学与肾脏学
CiteScore
3.90
自引率
13.30%
发文量
374
审稿时长
1 months
期刊介绍: Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.
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