Abstract: 【Abstract】Objective To observe the efficacy and safety of sacubitril/valsartan for the treatment of heart failure in maintenance hemodialysis patients. Methods Patients on hemodialysis complicated with chronic cardiac insufficiency and with stably controlled volume status were enrolled. They were treated with sacubitril/valsartan and followed up for 3 months. Before treatment with sacubitril/valsartan (baseline) and during follow- up, biomarkers of heart failure were tested, and volume status was assessed by body composition monitor (BCM). Changes of cardiac structure and function were examined by echocardiography. Results A total of 17 patients were included, while 4 patients withdrew due to drug-related adverse reactions and one due to renal transplantation during follow-up. Left ventricular ejection fraction (LVEF) increased from baseline 54.2±15.8% to endpoint 62.7±10.1% (t=-4.429, P=0.001) and greater improvement was found in patients with declined baseline LVEF (≤55%; t=-6.204, P=0.003), in line with a significant reduction in left ventricular end systolic volume (baseline 109.0±62.7ml vs. endpoint 79.4±52.1ml; t=4.725, P=0.009). In patients with normal LVEF, left ventricular posterior wall thickness decreased significantly (baseline 1.08 ± 0.27cm vs. endpoint
0.99 ± 0.16cm; t=3.176, P=0.025). The endpoints of serum creatinine (t=- 2.856, P=0.016), urea (t=- 3.149, P=0.009) and parathyroid hormone (baseline 328±161pg/ml vs. endpoint 409±191pg/ml; t=-2.230, P=0.048) elevated significantly as compared with the baseline values. Conclusion Sacubitril/valsartan significantly improves cardiac systolic function in hemodialysis patients with heart failure and reduces ventricular wall thickness in patients with normal LVEF. However, this treatment may also induce the increase of creatinine, urea and parathyroid hormone levels.

Key words: Hemodialysis, Heart failure, Sacubitril/valsartan, Secondary hyperparathyroidism