Lots of interesting abstracts and cases were submitted for TCTAP 2026. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge!
ABS20251101_0001
Comparative Effectiveness and Safety of Entresto, ACE Inhibitors, ARBs, and Placebo in Heart Failure Patients With End-Stage Renal Disease
By Bu Yuan Hsiao, Wan Ying Lin
Presenter
Bu Yuan Hsiao
Authors
Bu Yuan Hsiao1, Wan Ying Lin1
Affiliation
Taipei Medical University Hospital, Taiwan1
View Study Report
ABS20251101_0001
Pharmacotherapy (Heart Failure)
Comparative Effectiveness and Safety of Entresto, ACE Inhibitors, ARBs, and Placebo in Heart Failure Patients With End-Stage Renal Disease
Bu Yuan Hsiao1, Wan Ying Lin1
Taipei Medical University Hospital, Taiwan1
Background
Heart failure (HF) in patients with end-stage renal disease (ESRD) remains a major clinical challenge due to the complex hemodynamic and metabolic interplay between cardiac and renal dysfunction. While angiotensin receptor–neprilysin inhibitor (ARNI, sacubitril/valsartan) therapy has demonstrated mortality and hospitalization benefits in HFrEF patients, evidence in dialysis-dependent ESRD is limited. This study aimed to compare the real-world effectiveness and safety of ARNI versus angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non–RAAS inhibitors (placebo) among ESRD patients with HFrEF using the TriNetX global research network.
Methods
Methods:
We conducted a retrospective cohort study including adult ESRD patients on maintenance hemodialysis or peritoneal dialysis with HFrEF (LVEF < 40%) between January 2015 and December 2024. Patients were categorized into four groups: ARNI, ACEI, ARB, and placebo (no RAAS inhibition). The index date was defined as the first prescription of the assigned therapy. Propensity score matching (1:1) was performed to balance baseline covariates including age, sex, diabetes, hypertension, CAD, and stroke. The primary outcome was cardiovascular (CV) death. Secondary outcomes included HF hospitalization, LVEF improvement, and adverse events (hyperkalemia >5.5 mmol/L, hypotension). Kaplan–Meier survival and Cox proportional hazard models were used for analysis.
We conducted a retrospective cohort study including adult ESRD patients on maintenance hemodialysis or peritoneal dialysis with HFrEF (LVEF < 40%) between January 2015 and December 2024. Patients were categorized into four groups: ARNI, ACEI, ARB, and placebo (no RAAS inhibition). The index date was defined as the first prescription of the assigned therapy. Propensity score matching (1:1) was performed to balance baseline covariates including age, sex, diabetes, hypertension, CAD, and stroke. The primary outcome was cardiovascular (CV) death. Secondary outcomes included HF hospitalization, LVEF improvement, and adverse events (hyperkalemia >5.5 mmol/L, hypotension). Kaplan–Meier survival and Cox proportional hazard models were used for analysis.
Results
Results:
Among 12,400 eligible ESRD patients with HFrEF, 820 received ARNI, 2,850 received ACEI, 3,200 received ARB, and 5,530 received no RAAS inhibitor. Over a median follow-up of 3.1 years, ARNI use was associated with a significantly lower risk of CV death compared with ACEI (HR 0.78, 95% CI 0.64–0.95), ARB (HR 0.73, 95% CI 0.60–0.89), and placebo (HR 0.65, 95% CI 0.54–0.78). The rate of HF hospitalization was also reduced in the ARNI group (adjusted HR 0.70, 95% CI 0.57–0.86). LVEF improvement ≥10% was observed in 24.6% of ARNI users versus 17.2% with ACEI and 15.9% with ARB. Incidences of hyperkalemia (K⁺ >5.5 mmol/L) and symptomatic hypotension were comparable among groups (p>0.05).
Among 12,400 eligible ESRD patients with HFrEF, 820 received ARNI, 2,850 received ACEI, 3,200 received ARB, and 5,530 received no RAAS inhibitor. Over a median follow-up of 3.1 years, ARNI use was associated with a significantly lower risk of CV death compared with ACEI (HR 0.78, 95% CI 0.64–0.95), ARB (HR 0.73, 95% CI 0.60–0.89), and placebo (HR 0.65, 95% CI 0.54–0.78). The rate of HF hospitalization was also reduced in the ARNI group (adjusted HR 0.70, 95% CI 0.57–0.86). LVEF improvement ≥10% was observed in 24.6% of ARNI users versus 17.2% with ACEI and 15.9% with ARB. Incidences of hyperkalemia (K⁺ >5.5 mmol/L) and symptomatic hypotension were comparable among groups (p>0.05).
Conclusion
Conclusion:
In ESRD patients with HFrEF, sacubitril/valsartan therapy was associated with improved cardiovascular survival and reduced HF hospitalization without increasing hyperkalemia or hypotension risk compared with ACEIs, ARBs, or no RAAS blockade. These findings support the potential benefit and safety of ARNI in dialysis-dependent populations, warranting prospective validation.
In ESRD patients with HFrEF, sacubitril/valsartan therapy was associated with improved cardiovascular survival and reduced HF hospitalization without increasing hyperkalemia or hypotension risk compared with ACEIs, ARBs, or no RAAS blockade. These findings support the potential benefit and safety of ARNI in dialysis-dependent populations, warranting prospective validation.