{"title":"血液透析合并心力衰竭伴射血分数降低患者血管通路流量与沙比利/缬沙坦和左心室射血分数的关系","authors":"Fan-Yu Chen, Ann Charis Tan, Chyong-Mei Chen, Chih-Yu Yang, Kuo-Hua Lee, Shuo-Ming Ou, Ming-Tsun Tsai, Szu-Yuan Li, Tong-Jia Lin, Zih-Kai Kao, Chin-Te Tseng, Ya-Han Fu, Chih-Ching Lin","doi":"10.1093/ckj/sfaf078","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sacubitril/valsartan improves heart function in maintenance hemodialysis (HD) patients with heart failure with a reduced ejection fraction of <40% (HFrEF). However, the effect of sacubitril/valsartan on vascular access flow (Qa) in this population is still unclear.</p><p><strong>Methods: </strong>Hemodialysis patients with HFrEF were enrolled and divided into sacubitril/valsartan and non-sacubitril/valsartan treatment groups and received echocardiographic and Qa measurements at baseline and after 12 months. We compared the changes in Qa (△Qa) and echocardiographic parameters after 12 months. Correlations between △Qa and echocardiographic parameters were also examined. Multiple linear regression analysis was performed to predict △Qa.</p><p><strong>Results: </strong>Thirty-three HD patients with HFrEF were enrolled. Sixteen patients received sacubitril/valsartan treatment. Their mean Qa significantly increased from 633.8 to 948.8 mL/min (<i>P </i>< .001). There was no significant change in Qa for the non-sacubitril/valsartan treatment group (from 637.7 to 621.8 mL/min; <i>P </i>= .436). The change in left ventricular ejection fraction (△LVEF) differed significantly between the sacubitril/valsartan and conventional treatment groups (13.63 ± 11.35% and 1.59 ± 6.99%, respectively; <i>P </i>= .001). The △Qa was significantly correlated with △LVEF (<i>r</i> <sub>s</sub> = 0.929; <i>P </i>< .001) and with the change in interventricular septum thickness in diastole (△IVSd, <i>r</i> <sub>s</sub> = -0.736; <i>P </i>= .001) in the sacubitril/valsartan group. The △Qa was predicted as -44.034 + 15.868 × △LVEF-25.072 × △IVSd + 145.964 × <i>A</i> (<i>A</i> = 1 for sacubitril/valsartan use and <i>A</i> = 0 for non-sacubitril/valsartan treatment) mL/min (<i>R</i> <sup>2 </sup>= 0.909).</p><p><strong>Conclusion: </strong>In HD patients with HFrEF, treatment with sacubitril/valsartan is associated with improvement in LVEF and Qa over 12 months.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 4","pages":"sfaf078"},"PeriodicalIF":3.9000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986818/pdf/","citationCount":"0","resultStr":"{\"title\":\"The association of vascular access flow with sacubitril/valsartan and left ventricular ejection fraction in hemodialysis patients with heart failure with reduced ejection fraction.\",\"authors\":\"Fan-Yu Chen, Ann Charis Tan, Chyong-Mei Chen, Chih-Yu Yang, Kuo-Hua Lee, Shuo-Ming Ou, Ming-Tsun Tsai, Szu-Yuan Li, Tong-Jia Lin, Zih-Kai Kao, Chin-Te Tseng, Ya-Han Fu, Chih-Ching Lin\",\"doi\":\"10.1093/ckj/sfaf078\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sacubitril/valsartan improves heart function in maintenance hemodialysis (HD) patients with heart failure with a reduced ejection fraction of <40% (HFrEF). However, the effect of sacubitril/valsartan on vascular access flow (Qa) in this population is still unclear.</p><p><strong>Methods: </strong>Hemodialysis patients with HFrEF were enrolled and divided into sacubitril/valsartan and non-sacubitril/valsartan treatment groups and received echocardiographic and Qa measurements at baseline and after 12 months. We compared the changes in Qa (△Qa) and echocardiographic parameters after 12 months. Correlations between △Qa and echocardiographic parameters were also examined. Multiple linear regression analysis was performed to predict △Qa.</p><p><strong>Results: </strong>Thirty-three HD patients with HFrEF were enrolled. Sixteen patients received sacubitril/valsartan treatment. Their mean Qa significantly increased from 633.8 to 948.8 mL/min (<i>P </i>< .001). There was no significant change in Qa for the non-sacubitril/valsartan treatment group (from 637.7 to 621.8 mL/min; <i>P </i>= .436). The change in left ventricular ejection fraction (△LVEF) differed significantly between the sacubitril/valsartan and conventional treatment groups (13.63 ± 11.35% and 1.59 ± 6.99%, respectively; <i>P </i>= .001). The △Qa was significantly correlated with △LVEF (<i>r</i> <sub>s</sub> = 0.929; <i>P </i>< .001) and with the change in interventricular septum thickness in diastole (△IVSd, <i>r</i> <sub>s</sub> = -0.736; <i>P </i>= .001) in the sacubitril/valsartan group. The △Qa was predicted as -44.034 + 15.868 × △LVEF-25.072 × △IVSd + 145.964 × <i>A</i> (<i>A</i> = 1 for sacubitril/valsartan use and <i>A</i> = 0 for non-sacubitril/valsartan treatment) mL/min (<i>R</i> <sup>2 </sup>= 0.909).</p><p><strong>Conclusion: </strong>In HD patients with HFrEF, treatment with sacubitril/valsartan is associated with improvement in LVEF and Qa over 12 months.</p>\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":\"18 4\",\"pages\":\"sfaf078\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-03-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986818/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfaf078\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfaf078","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：Sacubitril/缬沙坦改善维护性血液透析（HD）心力衰竭患者的心功能，并降低射血分数方法：纳入血透患者HFrEF，分为Sacubitril/缬沙坦治疗组和非Sacubitril/缬沙坦治疗组，并在基线和12个月后接受超声心动图和Qa测量。比较12个月后的Qa（△Qa）和超声心动图参数的变化。此外，还研究了△Qa与超声心动图参数的相关性。采用多元线性回归分析预测△Qa。结果：33例合并HFrEF的HD患者入组。16例患者接受苏比里尔/缬沙坦治疗。平均Qa由633.8 mL/min显著升高至948.8 mL/min （P = 0.436）。左室射血分数（△LVEF）变化在苏比利/缬沙坦治疗组与常规治疗组之间差异有统计学意义（分别为13.63±11.35%和1.59±6.99%）；p = .001)。△Qa与△LVEF显著相关(r s = 0.929；P r s = -0.736；P = .001)。预测△Qa为-44.034 + 15.868 ×△LVEF-25.072 ×△IVSd + 145.964 × A (sacubitril/缬沙坦组A = 1，非sacubitril/缬沙坦组A = 0) mL/min （r2 = 0.909）。结论：在合并HFrEF的HD患者中，使用苏比里尔/缬沙坦治疗可在12个月内改善LVEF和Qa。
The association of vascular access flow with sacubitril/valsartan and left ventricular ejection fraction in hemodialysis patients with heart failure with reduced ejection fraction.
Background: Sacubitril/valsartan improves heart function in maintenance hemodialysis (HD) patients with heart failure with a reduced ejection fraction of <40% (HFrEF). However, the effect of sacubitril/valsartan on vascular access flow (Qa) in this population is still unclear.
Methods: Hemodialysis patients with HFrEF were enrolled and divided into sacubitril/valsartan and non-sacubitril/valsartan treatment groups and received echocardiographic and Qa measurements at baseline and after 12 months. We compared the changes in Qa (△Qa) and echocardiographic parameters after 12 months. Correlations between △Qa and echocardiographic parameters were also examined. Multiple linear regression analysis was performed to predict △Qa.
Results: Thirty-three HD patients with HFrEF were enrolled. Sixteen patients received sacubitril/valsartan treatment. Their mean Qa significantly increased from 633.8 to 948.8 mL/min (P < .001). There was no significant change in Qa for the non-sacubitril/valsartan treatment group (from 637.7 to 621.8 mL/min; P = .436). The change in left ventricular ejection fraction (△LVEF) differed significantly between the sacubitril/valsartan and conventional treatment groups (13.63 ± 11.35% and 1.59 ± 6.99%, respectively; P = .001). The △Qa was significantly correlated with △LVEF (rs = 0.929; P < .001) and with the change in interventricular septum thickness in diastole (△IVSd, rs = -0.736; P = .001) in the sacubitril/valsartan group. The △Qa was predicted as -44.034 + 15.868 × △LVEF-25.072 × △IVSd + 145.964 × A (A = 1 for sacubitril/valsartan use and A = 0 for non-sacubitril/valsartan treatment) mL/min (R2 = 0.909).
Conclusion: In HD patients with HFrEF, treatment with sacubitril/valsartan is associated with improvement in LVEF and Qa over 12 months.
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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