Efficacy and safety of sacubitril/valsartan in end-stage renal disease patients with heart failure: a review

PURPOSE: End-stage renal disease (ESRD) is associated with a heavy global public health burden and an increased risk of cardiovascular diseases. Sacubitril/valsartan has been shown to improve cardiovascular outcomes in patients with heart failure and delay the progression of chronic kidney disease. We aim to perform a comprehensive analysis of current clinical evidence on the use of sacubitril/valsartan in ESRD patients. METHODS: We searched PubMed, Embase, and Web of Science using keywords such as 'sacubitril/valsartan', 'end-stage renal disease', 'hemodialysis' and 'heart failure'. The search deadline is December 20, 2024. In this review, we discuss the pharmacological mechanisms, pharmacokinetics, and latest clinical evidence of the administration of sacubitril/valsartan in ESRD patients with heart failure. RESULTS: Sacubitril/valsartan contains sacubitril and valsartan that can regulate the renin-angiotensin-aldosterone system and natriuretic peptides simultaneously. For ESRD patients with heart failure, particularly those with reduced ejection fraction, sacubitril/valsartan demonstrated potential benefits including improved ventricular remodeling, enhanced left ventricular ejection fraction, and reduced mortality and heart failure re-hospitalization rates, while maintaining a favorable safety profile with no significant increased risk of hyperkalemia or hypotension. This review further discusses current challenges and future directions, including health economic evaluations and adverse event management strategies, to optimize clinical decision-making for the use of sacubitril/valsartan in this high-risk population. CONCLUSION: Sacubitril/valsartan may benefit ESRD patients with heart failure by improving ventricular remodeling and cardiac function while reducing mortality and hospitalization risks, without major safety concerns. However, larger studies are needed for confirmation.