Risk stratification for worsening renal function and renal decline in heart failure patients with reduced ejection fraction after sacubitril/valsartan treatment.

In the real-world setting, data regarding renal decline following sacubitril/valsartan treatment are lacking. This study aimed to develop a scoring system to predict renal outcome in sacubitril/valsartan-treated patients. Between 2017 and 2018, a total of 1505 heart failure patients with reduced ejection fraction (HFrEF) undergoing sacubitril/valsartan treatment were consecutively enrolled from 10 hospitals to serve as the derivation cohort. Another 1620 HFrEF patients receiving sacubitril/valsartan were included as the validation cohort. Worsening renal function (WRF) was defined as a serum creatinine increase of > 0.3 mg/dL and/or > 25 % at 8 months of sacubitril/valsartan treatment. The derivation cohort was used to identify independent predictive factors for WRF through multivariate analysis, which were then used to develop the risk score system. Among the 3125 HFrEF patients, 689 (22.0 %) patients had WRF at 8 months following sacubitril/valsartan treatment. In the derivation cohort, six prognostic factors (age, functional class, history of peripheral arterial disease, diabetes mellitus, gout or hyperuricemia, and serum albumin level) were independently associated with WRF, and were combined into a risk predicting score. This score showed accurate discrimination in the derivation and validation cohorts (Harrell's concordance indexes 0.74 and 0.71, 95 % confidence intervals 0.71–0.78 and 0.69–0.74, respectively). Patients with a higher risk score experienced a more rapid decline in renal function, poorer clinical outcomes, and a higher rate of discontinuation of sacubitril/valsartan treatment. This study developed a score for WRF after sacubitril/valsartan treatment, which may assist clinicians with risk stratification and therapeutic decision-making. A score for worsening renal function after sacubitril/valsartan use is developed. B/L, baseline; Cr, serum creatinine; DM, diabetes mellitus; HFrEF, heart failure with reduced ejection fraction; N/A, not available; NYHA, New York Heart Association; PAD, peripheral arterial disease; TAROT-HF, treatment with angiotensin receptor neprilysin inhibitor for Taiwan heart failure patients study; WRF, worsening renal function. [Display omitted] • Six prognostic factors were independently associated with worsening renal function. • A scoring system for worsening renal function following angiotensin receptor neprilysin inhibitor use was developed. • Higher scores correlate with faster renal decline and poorer outcomes. [ABSTRACT FROM AUTHOR]