Reviews in Cardiovascular Medicine ![](https://rcm.imrpress.com/images/dao.gif)
2020,
Vol. 21 ![](https://rcm.imrpress.com/images/dao.gif)
Issue (1): 113-118
DOI: 10.31083/j.rcm.2020.01.2
LCZ696 and preservation of renal function in heart failure: A meta-analysis of 6 randomized trials
Xiaogen Chen1, †, Chunna Jin1, †, Lan Xie1, Meixiang Xiang1, *(
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)
1Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Key Lab of Cardiovascular Disease of Zhejiang Province, Hangzhou,
Zhejiang 310009, P. R. China
Abstract:
Patients with heart failure (HF) are prone to combine with renal insufficiency. Recently, LCZ696 has been used in the treatment of HF, but whether LCZ696 is better than angiotensin converting enzyme inhibitors/angiotensin receptor antagonists (ACEI/ARB) in renal protection for HF patients has not been investigated. Therefore, we conducted a meta-analysis focusing on LCZ696 and its role in preservation of renal function in HF patients. Embase, PubMed, the Cochrane Library and ClinicalTrials.gov databases were electronically searched for available randomized controlled trials (RCTs). HF patients taking LCZ696 or ACEI/ARB were assessed for renal adverse events. The last search date was Sep 20, 2019. A total of 14959 patients from 6 trials were included in this meta-analysis. As compared to ACEI/ARB, LCZ696 significantly reduced the risk of renal function deterioration (odds ratio 0.77, 95% confidence interval 0.61-0.97, P = 0.02). In summary, LCZ696 may have superior renal protection in HF patients compared with ACEI/ARB.
Submitted: 04 January 2020
Accepted: 03 March 2020
Published: 30 March 2020
Fund:
WKJ-ZJ-1703 to Meixiang Xiang/Provincial and Ministry Joint Major Projects of National Health Commission of China
81700412/National Natural Science Foundation of China
*Corresponding Author(s):
Meixiang Xiang
E-mail: xiangmx@zju.edu.cn
About author: † These authors contributed equally.
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Xiaogen Chen
Chunna Jin
Lan Xie
Meixiang Xiang
Figure 1. Literature screening flow chart
Table 1. Baseline Characteristics of Trials included in the Meta-Analysis
![](https://rcm.imrpress.com/images/table-icon.gif)
Trial
NameNumber of ParticipantsFollow-up
Definition of
decline in
renal functionInclusion criteriaAge(years)Gender
(male)Control groupBaseline
Serum Cr
(mg/dl)Baseline eGFR
(ml/min per
1.73 m ^2)PARAMOUNT-HF (2012)3013monthsScr ≥ 0.5 mg/dL↑ and/or > 25%↑NYHA II-III
HFpEF,
EF ≥ 45%70.9 ± 9.4152 (57%)Valsartan66.5 ± 19.4
VS.
64.3 ± 21.3PARADIGM-HF
(2014)844227monthsend-stage renal disease,
50% ↓GFR,
30 ↓GFR to < 60ml/min.per 1.73 m^2NYHA II-IV,
EF ≤ 40%63.8 ± 11.5
VS.
63.8 ± 11.36567 (78%)Enalapril1.13 ± 0.3
VS.
1.27 ± 0.03PIONEER-HF (2019)8818weeksScr ≥ 0.5 ↑mg/dL (≥ 44 μmol/L) ,
25%↓ GFR.Hemody-namic stabilization after ADHF EF≤40%61 (51-71)
VS. 63 (54-72)635 (72.1%)Enalapril1.28 (1.07-1.51)
VS.
1.27 (1.05-1.50)58.4 (47.5-71.5)
VS.
58.9 (47.4-70.9)EVALUATE-H (2019)46412 weeks.35%↓GFR,
Scr ≥ 0.5 ↑mg/dL AND
25%↓GFRHypertension;
EF ≤ 40% NYHA I-III67.8 (9.8)
VS.
66.7 (8.5)355 (76.5%)Enalapril70 (22)
VS.
69 (20)PRIME (2019)11812monthsSCr ≥ 2.5mg/dL(NYHA) II or III
EF of 25% to < 50% and significant functional MR(64.7 ± 10.2)
VS.
(60.5 ± 11.8)672 (61%)Valsartan(1.00 ± 0.32)
VS
0.98 ± 0.28PARAGONHF (2019)482226monthsdeath from renal failure, end?stage renal disease, or 50% ↓GFRNYHA class II toIV
EF ≥ 45%72.7 ± 8.3
VS.
72.8 ± 8.52317 (48.3%)Valsartan1.1 ± 0.3
VS
1.1 ± 0.3)63 ± 19
VS
62 ± 19
Figure 2. Forest plot of worsening renal function comparison: LCZ696 group vs ACEI/ARB group
Figure 3. Forest map of 6 RCTs
Figure 4. Forest plot of worsening renal function comparison: LCZ696 group vs ACEI/ARB group afterexcluding the PIONEER-HF
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