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Home › Cardiology › Sacubitril/valsartan improves LVEF and NT-proBNP levels in patients with heart failure on peritoneal dialysis

Sacubitril/valsartan improves LVEF and NT-proBNP levels in patients with heart failure on peritoneal dialysisSacubitril/Valsartan Shows Potential Benefits for Heart Failure Patients

Jornal brasileiro de nefrologia Published July 1, 2026 Study authors: Silva Caio Lima da, Fonseca Pandora Eloa Oliveira, Calice-Silva Viviane, Ponce Daniela, Rocha Paulo … PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway
Consider sacubitril/valsartan as a potential option to improve LVEF and NT-proBNP in heart failure patients on peritoneal dialysis.

This meta-analysis synthesized data from 8 observational studies and 1 RCT to evaluate the effects of sacubitril/valsartan in patients with heart failure undergoing peritoneal dialysis. The analysis pooled results from a sample size of 343 patients.

Key findings include significant improvements in left ventricular ejection fraction (LVEF) with an MD of 5.22 (95% CI, 3.86 to 6.58; p < 0.0001). Additionally, NT-proBNP levels were reduced by a mean difference of -5630.40 (95% CI, -9177.57 to -2083.23; p = 0.0019), and systolic blood pressure was reduced by an MD of -14.59 (95% CI, -20.59 to -8.59; p < 0.0001). No statistically significant changes were observed in left atrial diameter (p = 0.0561) or left ventricular end-diastolic dimension (p = 0.1037).

The safety profile was reported as generally acceptable, with hypotension and angioedema occurring as rare events. Hyperkalemia showed a slight increase of 11.94%. The authors note that LVEF improvement is a surrogate for cardiac function and NT-proBNP reduction is a surrogate for heart failure management. Results are limited by the need for confirmation in adequately powered RCTs.

How this fits prior evidence

This meta-analysis addresses a gap in evidence regarding pharmacological management of heart failure specifically in patients undergoing peritoneal dialysis. While previous coverage has identified risk factors such as a lower prognostic nutritional index and high delirium rates in heart failure, this finding provides specific data on the efficacy of sacubitril/valsartan for cardiac markers like LVEF (MD 5.22) and NT-proBNP reduction (MD -5630.40).

This analysis looked at 343 patients with heart failure who were undergoing peritoneal dialysis. Researchers combined results from eight observational studies and one clinical trial to see how the medication sacubitril/valsartan affected heart health.

The findings showed that patients taking this medication had significantly improved left ventricular ejection fraction, which is a measure of heart pumping strength. The study also found lower levels of NT-proBNP, a marker used to manage heart failure, and a decrease in systolic blood pressure. However, other measures like left atrial diameter and left ventricular end-diastolic dimension did not show significant changes.

Safety results showed that the medication was generally well tolerated. While some patients experienced high potassium levels (hyperkalemia), cases of low blood pressure or swelling were rare. Because this data comes from a mix of observational studies, more large-scale trials are needed to confirm these findings before they can change standard medical practice.

What this means for you:
Sacubitril/valsartan may improve heart function and lower blood pressure in some patients on peritoneal dialysis.

Common questions

What specific heart benefits were found?

The study showed that sacubitril/valsartan significantly improved the left ventricular ejection fraction, which measures how well the heart pumps. It also led to a significant reduction in NT-proBNP levels and lower systolic blood pressure in patients undergoing peritoneal dialysis.

Is this medication safe for patients on dialysis?

The medication had an overall acceptable safety profile. While there was a slight increase in hyperkalemia (high potassium), other issues like hypotension and angioedema were reported as rare events.

How certain are these results for heart failure patients?

Because the data comes from a mix of observational studies and one trial, more large-scale clinical trials are needed to confirm these findings. You should talk to your doctor about how this might apply to your specific treatment plan.

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Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJan 2026
PMID41931676
View Original Abstract ↓
BACKGROUND: Sacubitril/valsartan is a recommended medication for managing heart failure (HF). However, its role in peritoneal dialysis (PD) patients remains uncertain. We conducted this systematic review and singlearm meta-analysis to assess the efficacy and safety of sacubitril/valsartan in this population. METHODS: We systematically searched PubMed, EMBASE, and Cochrane Central until December 2024 for randomized controlled trials (RCTs) and observational studies assessing changes in left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, systolic blood pressure (SBP), left atrial diameter (LAD), and left ventricular end-diastolic dimension (LVDd) with sacubitril/valsartan use in PD patients. Safety endpoints included hyperkalemia, hypotension, and angioedema. Statistical analyses were performed in R, using proportions for binary and mean differences (MDs) for continuous outcomes. RESULTS: Nine studies were included, comprising 8 observational studies and 1 RCT, involving 343 PD patients. LVEF improved significantly (MD 5.22; 95% CI, 3.86 to 6.58; p < 0.0001; I2 = 38.9%). Sacubitril/valsartan reduced NT-proBNP levels (MD -5630.40; 95% CI, -9177.57 to -2083.23; p = 0.0019; I2 = 86%) and SBP (MD -14.59; 95% CI, -20.59 to -8.59; p < 0.0001; I2 = 93.5%). No statistically significant changes were noted in LAD (p = 0.0561) or LVDd (p = 0.1037). Hypotension and angioedema were rare events, whereas hyperkalemia showed a slight increase (11.94%). CONCLUSION: Sacubitril/valsartan was associated with improvements in cardiac function surrogates and blood pressure in PD patients with HF, with an overall acceptable safety profile despite a modest increase in hyperkalemia. These findings suggest potential benefit in this understudied population, though confirmation in adequately powered RCTs remains necessary.
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