Effects of sacubitril valsartan on renal function and renal safety in patients with heart failure: a Meta-analysis

Objective To evaluate the effects of sacubitril valsartan on renal function and renal safety in patients with heart failure(HF) so as to provide evidence-based medical rationales for clinical application. Methods Randomized controlled trials on treating HF with sacubitril valsartan were retrieved from the databases of PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials. gov, China National Knowledge Infrastructure(CNKI), WangFang and WeiPu from the inceptions until December 2021. Screening the relevant literatures and extracting data were performed according to the Cochrane Systematic Evaluator's Manual 5.1. 0. And RevMan 5.3 software utilized for a Meta-analysis of renal outcomes and renal safety parameters. Results A total of 8 articles involving 15596 HF patients were retrieved. Control group received angiotensin-converting enzyme inhibitor(ACEI) or angiotensin receptor blocker(ARB). Meta-analysis revealed that, as compared with ACEI/ARB, sacubitril valsartan significantly improved estimated glomerular filtration rate(eGFR)MD=1.86 mL·min^-1·(1.73m²)^-1, 95%CI:(0.89, 2.84), P=0.0002and boosted urinary albumin/creatinine ratio(uACR)MD=0.31 mg/mmol, 95%CI(0.11, 0.51), P=0.002. In terms of renal safety, sacubitril valsartan significantly lowered the risk of worsening renal function(WRF)OR=0.82, 95%CI(0.70, 0.97), P=0.02, acute kidney injury(AKI)OR=0.84, 95%CI(0.74, 0.97), P=0.02and progression to end-stage renal disease (ESRD)OR=0.51, 95%CI(0.29, 0.89), P=0.02. Although no significant difference existed in risk of overall hyperkalemia(≥ 5.5 mmol/L)OR=1.03, 95%CI(0.86, 1.22), P=0.78, sacubitril valsartan reduced the risk of severe hyperkalemia(≥ 6.0 mmol/L)OR=0.79, 95%CI(0.67, 0.92), P=0.003. Conclusion As compared with ACEI/ARB, sacubitril valsartan delays the decline of eGFR in HF patients. It is accompanied by a mild elevation of uACR. Renal benefit of sacubitril valsartan is superior to that of ACEI/ARB with a higher renal safety and a lower incidence of renal adverse events.