Effects of sacubitril-valsartan in patients undergoing maintenance dialysis.

OBJECTIVES: Data on angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril-valsartan (SV) in patients undergoing maintenance dialysis is scarce. Our study aimed to investigate the effect of SV on patients undergoing dialysis. METHODS: We retrospectively reviewed the data of end-stage kidney disease (ESRD) patients undergoing either peritoneal dialysis (PD) or hemodialysis (HD) in our center. A total of 51 patients receiving SV treatment were enrolled in the SV group. Another 51 age and sex-matched patients on dialysis without SV treatment were selected as the control group. All the patients were regularly followed up in the dialysis clinic. Their clinical, biochemical, and echocardiographic parameters were all recorded at baseline and during follow-up. The effect and safety of SV were further analyzed. RESULTS: A total of 102 ESRD patients on dialysis (51 patients in the SV group and 51 patients in the control group) were finally enrolled. The median follow-up time was 349 days (interquartile range [IQR]: 217-535 days). The level of B-type natriuretic peptide (BNP) (median [IQR] before and after SV treatment: 596.35 pg/ml [190.6-1714.85] vs. 188.7 pg/ml [83.34-600.35], p < 0.001) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) (median [IQR]: 6316.00 pg/ml [4552.00-28598.00] vs. 5074.00 pg/ml [2229.00-9851.00], p = 0.022) were significantly decreased after treatment with SV. The variant rate of left ventricular ejection fraction (LVEF) was significantly higher in the SV group compared to the control group, especially in the PD subgroup. No significant difference was found in other echocardiographic parameters between SV and control group. Subgroup analysis of the PD group showed an increase in daily PD ultrafiltration (median [IQR]: 400 ml/d [200-500] vs. 500 ml/d [200-850], p = 0.114) after SV treatment. Variant rate of overhydration (OH) measured by the body composition monitor (BCM) of the SV group were significantly different from the control group (median [IQR]: -13.13% [-42.85%-27.84%] vs. 0% [-17.95%-53.85%], p = 0.049). The rate of hyperkalemia was slightly higher but without significant difference before and after the introduction of SV (19.6% vs. 27.5%, p = 0.350). No event of hypotension and angioedema were observed. CONCLUSIONS: SV might have a cardio-protective role in ESRD patients undergoing dialysis, especially in PD patients. Serum potassium should be monitored during the treatment.

[A multiplicity of morbidity and prognostic factors in patients with septic and acute kidney injury].

OBJECTIVE: To investigate the risk factors of morbidity and prognosis in patients with acute kidney injury (AKI) due to sepsis. METHODS: A case-control retrospective study was carried out in AKI patients with/without sepsis from February 2000.to March 2010. APACHE III and ATN-ISI were calculated. Multivariate logistic regression analysis was used to explore the clinical data and the risk factors of morbidity and prognosis in patients with septic AKI. RESULTS: (1) The overall mortality rate was 23.3% and the mortality rate of septic AKI patients 44.6%. (2) With no correlation with the level of D-dimer (r = 0.356, P = 0.019), the number of failed organs was positively correlated with the mortality rate in septic AKI patients (r = 0.545, P < 0.01). (3) As demonstrated by multivariate analysis, D-dimer (> 2.2 mg/L), supports of vasoactive agents, APTT (activated partial thromboplastin time) (> 50 s) were the pathogenetic risk factors for septic AKI patients; APACHE III score (> 60), the number of failed organs, supports of mechanical ventilation were the prognostic risk factors for septic AKI patients. CONCLUSIONS: The pathogenetic risk factors of septic AKI patients are D-dimer (> 2.2 mg/L), supports of vasoactive agents and APTT (> 50 s); APACHE III score (> 60), the number of failed organs and supports of mechanical ventilation are the prognostic risk factors for septic AKI patients. D-dimer may predict the morbidity of septic AKI patients, but it can not predict their prognoses.