The Effect Of Arni On The Functional State Of The Kidneys In Patients With IHD
Keywords:
Abstract
Purpose of the study: сomparative study of the effect of ARNI (combination of valsartan and sacubitrile) on the structural and functional state of the kidneys in patients with IHD after revascularization.
Material and research methods. The study included 320 patients with coronary artery disease. 37 patients underwent surgical revascularization (CABG), 283 patients underwent endovascular revascularization. On average, the concentration of creatinine was 90.08 ± 1.72 µmol /l. All patients were divided into 2 groups: patients who received the drug valsartan (group B, 160 people), patients who received a combination of valsartan and sacubitril a (ARNI - a combination of a molecule of valsartan and an inhibitor of neprilysin sacubitril in a molar ratio of 1: 1) (group C, 160 people). Also, all patients were divided into 2 subgroups depending on the degree of eGFR decrease by the 3rd month of observation: patients with a decrease in eGFR by the 3rd month of observation more than 20% (group 1 - 59 patients) and less than 20% (group 2 - 261 sick). In dynamics, three months later, at the end of the first and second years of follow-up after revascularization, the patients underwent determination of the blood creatinine concentration, with the calculation of GFR and ultrasound examination (US) of the kidneys with dopplerography of the segmental arteries.
Research results. The study showed that during 2 years of follow-up after coronary revascularization, there was a decrease in eGFR in both groups of patients, regardless of the therapy. Comparative analysis of the dynamics of eGFR between patients with different treatment regimens, depending on the severity of the decrease in eGFR, showed that the dynamics of the progression of CKD was significantly greater in patients with decreased eGFR by the 3rd month of therapy by 20% or more compared with patients who received sacubitril in the therapy regimen.The difference becomes significant only by the 1st year of observation and persists by the 2nd year of observation. Resistivity index of renal segmental arteries by the end of observation in-group C was significantly (p <0.05) lower than in-group B.
Conclusion. The inclusion of ARNI (a combination of valsartan and sacubitril) in the IHD treatment regimen contributes to a significant decrease in the rate of progression of CKD in patients prone to rapid progression of type II cardiorenal syndrome. Against the background of ARNI application, there was a tendency to slow down the progression of pathological renal glomerular vascular remodeling.
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References
Mortality G.B.D. Causes of death C. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015; 385:117–71.
Yancy C.W, Jessup M., Bozkurt B., Butler J., Casey DE Jr, Drazner M.H., Fonarow G.C. et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):1810–1852.
Hadjiphilippou S., Kon S.P. Cardiorenal syndrome: review of our current understanding. J R Soc Med. 2016;109(1):12–17.
Vodovar N., Seronde M.F., Laribi S., Gayat E., Lassus J., Januzzi J.L., Jr, et al. Elevated plasma B-type natriuretic peptide concentrations directly inhibit circulating neprilysin activity in heart failure. JACC Heart Fail. 2015; 3:629–36.
Quiroga B., Ú Verdalles, J. Reque, S. García de Vinuesa, M. Goicoechea, J. Luño.Cardiovascular events and mortality in chronic kidney disease (stages I–IV). //Nefrologia, 33 (2013), pp. 539-545
Go A.S., Chertow G.M., D. Fan, C.E. McCulloch, C.Y. Hsu.Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.//N Engl J Med, 351 (2004), pp. 1296-1305
Bloom M.W., Greenberg B., Jaarsma T., Januzzi J.L., Lam C.S.P., A.P. Maggioni, et al.Heart failure with reduced ejection fraction.//Nat Rev Dis Primers, 3 (2017), pp. 17058
Schefold J.C., Filippatos G., Hasenfuss G., Anker S.D., S. von Haehling.Heart failure and kidney dysfunction: epidemiology, mechanisms and management. //Nat Rev Nephrol, 12 (2016), pp. 610-623
Yancy C.W., Jessup M., Bozkurt B., et al. American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2013; 62(16):e147–e239.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016; 18:891–975.
Makani H, Bangalore S, Desouza KA, Shah A, Messerli FH. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. BMJ. 2013; 346:f360.
McMurray J.J., M. Packer, A.S. Desai, J. Gong, M.P. Lefkowitz, A.R. Rizkala, et al.PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure.//N Engl J Med, 371 (2014), pp. 993-1004
Senni M., J.J. McMurray, R. Wachter, H.F. McIntyre, A. Reyes, I. Majercak, et al.Initiating sacubitril/valsartan (LCZ696) in heart failure: results of TITRATION, a double-blind, randomized comparison of two uptitration regimens.//Eur J Heart Fail., 18 (2016), pp. 1193-1202
Di Lullo L, Reeves PB, Bellasi A, Ronco C. Cardiorenal Syndrome in Acute Kidney Injury. Semin Nephrol. 2019;39(1):31–40.
Hadjiphilippou S, Kon SP. Cardiorenal syndrome: review of our current understanding. J R Soc Med. 2016;109(1):12–17.
De Vecchis R., Baldi C. Cardiorenal syndrome type 2: from diagnosis to optimal management. Ther. Clin. Risk Manag. 2014;10:949–961.
Mann D.L., Hassenfuss G. Pathophysiology of Heart Failure in part IV Heart Failure of Braunwald’s Heart Diseases. Edn Mann DL, Zipes DP, Libby P. Bonow, RO: Elsevier Saunders; 2015.
Jhund PS, Claggett B, Packer M, Zile MR, Voors AA, Pieske B, et al. Independence of the blood pressure lowering effect and efficacy of the angiotensin receptor neprilysin inhibitor, LCZ696, in patients with heart failure with preserved ejection fraction: an analysis of the PARAMOUNT trial. Eur J Heart Fail. 2014;16:671–7.
Solomon SD, Zile M, Pieske B. et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet 2012; 380: 1387–1395.
Voors AA, Gori M, Liu LC. et al. Renal effects of the angiotensin receptor neprilysin inhibitor LCZ696 in patients with heart failure and preserved ejection fraction. Eur Journal Heart Fail 2015; 17: 510–517 [PubMed] [Google Scholar]
Ito S, Satoh M, Tamaki Y, Gotou H, Charney A, Okino N, et al. Safety and efficacy of LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, in Japanese patients with hypertension and renal dysfunction. Hypertens Res. 2015; 38:269–75
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