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Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with heart failure and preserved ejection fraction
Author(s) -
Voors Adriaan A.,
Gori Mauro,
Liu Licette C.Y.,
Claggett Brian,
Zile Michael R.,
Pieske Burkert,
McMurray John J.V.,
Packer Milton,
Shi Victor,
Lefkowitz Martin P.,
Solomon Scott D.
Publication year - 2015
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.232
Subject(s) - valsartan , medicine , renal function , ejection fraction , sacubitril , heart failure , creatinine , endocrinology , sacubitril, valsartan , urology , cardiology , discontinuation , angiotensin ii , blood pressure
Background Increases in serum creatinine with renin–angiotensin–aldosterone system ( RAAS ) inhibitors can lead to unnecessary discontinuation of these agents. The dual‐acting angiotensin receptor neprilysin inhibitor LCZ696 improves clinical outcome patients with heart failure with reduced ejection fraction, and pilot data suggest potential benefit in heart failure with preserved ejection fraction ( HFpEF ). The effects of LCZ696 on renal function have not been assessed. Methods and results A total of 301 HFpEF patients were randomly assigned to LCZ696 or valsartan in the PARAMOUNT trial. We studied renal function [creatinine, estimated glomerular filtration rate ( eGFR ), cystatin C, and urinary albumin to creatinine ratio ( UACR )] at baseline, 12 weeks, and after 36 weeks of treatment. Worsening renal function ( WRF ) was determined as an serum creatinine increase of >0.3 mg/ dL and/or >25% between two time‐points. Mean eGFR at baseline was 65.4 ± 20.4 mL /min per 1.73 m 2 . The eGFR declined less in the LCZ696 group than in the valsartan group (–1.5 vs. –5.2 mL /min per 1.73 m 2 ; P = 0.002). The incidence of WRF was lower in the LCZ696 group (12%) than in the valsartan group (18%) at any time‐point, but this difference was not statistically significant ( P = 0.18). Over 36 weeks, the geometric mean of UACR increased in the LCZ696 group (2.4–2.9 mg/mmol), whereas it remained stable in the valsartan group (2.1–2.0 mg/mmol; P for difference between groups = 0.016). Conclusion In patients with HFpEF , therapy with LCZ696 for 36 weeks was associated with preservation of eGFR compared with valsartan therapy, but an increase in UACR .