Association of angiotensin receptor-neprilysin inhibitor therapy with changes in eGFR slope and home blood pressure in patients with chronic kidney disease.

BACKGROUND: Evidence regarding the renoprotective effects of angiotensin receptor-neprilysin inhibitor (ARNI) in patients with chronic kidney disease (CKD) remains limited. We investigated the association of ARNI initiation with changes in estimated glomerular filtration rate (eGFR) slope and home blood pressure in patients with non-dialysis CKD. METHODS: This retrospective single-center study included 89 patients with non-dialysis CKD who were switched from renin-angiotensin system inhibitors to sacubitril/valsartan because of insufficient blood pressure control. Changes in eGFR slope before and after ARNI initiation were evaluated using linear mixed-effects models. Associations between post-treatment home systolic blood pressure (post-HSBP) and eGFR slope were also assessed. RESULTS: Mean age was 72 ± 11 years, and baseline eGFR was 29 ± 15 mL/min/1.73 m2. The eGFR slope changed from - 3.81 to - 1.28 mL/min/1.73 m2/year after ARNI initiation, corresponding to a slope difference of + 2.52 mL/min/1.73 m2/year (95% CI, 1.98 to 3.06; P < 0.001). Home blood pressure decreased from 136 ± 13/79 ± 12 to 130 ± 10/75 ± 10 mmHg (both P < 0.01). Lower post-HSBP was associated with greater attenuation of eGFR decline in the interaction analysis (β =  - 0.83, 95% CI - 1.51 to - 0.14; P = 0.018). ARNI was generally well tolerated throughout the observation period. CONCLUSIONS: In patients with non-dialysis CKD, ARNI initiation was associated with attenuation of eGFR decline and improved blood pressure control. Better home blood pressure control was associated with greater attenuation of eGFR decline. These findings support a potential role of ARNI as a treatment option for patients with CKD and insufficient blood pressure control despite RAS inhibitor therapy.