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Diuretic and renal effects of angiotensin receptor-neprilysin inhibitor in patients hospitalized for acute heart failure

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Abstract

In patients hospitalized for acute decompensation of heart failure (HF), the impact of angiotensin receptor-neprilysin inhibitor (ARNI) on diuresis and renal function has not been fully investigated. Patients with HF and reduced ejection fraction who were hospitalized for acute decompensation and newly initiated ARNI after hemodynamic stabilization were enrolled. Changes in urine volume (UV), body weight, estimated glomerular filtration rate (eGFR), and urine N-acetyl-beta-d-glucosaminidase (uNAG) levels before and after ARNI initiation were investigated. Changes in the diuretic response [DR, calculated as urine volume/(intravenous furosemide volume/40 mg)], N-terminal pro-brain natriuretic peptide (NT-proBNP), hematocrit, and plasma volume (PV) were also evaluated. A total of 60 patients were enrolled. ARNI was initiated at a median of 6 [5, 7] days after hospitalization. After initiation of ARNI, body weight, NT-proBNP, and PV decreased. UV and DR increased only on the day of ARNI initiation (delta UV 400 ± 957 ml and delta DR 1100 ± 3107 ml/40 mg furosemide) and then decreased to baseline levels. In the multivariable linear regression analysis, younger age, higher BMI, and higher NT-proBNP levels were significantly associated with greater UV after ARNI initiation. eGFR and uNAG did not significantly change after the initiation of ARNI [delta eGFR -1.7 ± 12.0 mL/min/1.73 m2 and delta uNAG 2.0 (−5.6, 6.9) IU/L]. In patients hospitalized for HF, the initiation of ARNI was associated with a small and transient increase in UV and DR, and was not associated with worsening of renal function or tubular injury.

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Authors and Affiliations

  1. Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-Cho 1, Chiyoda-Ku, Tokyo, 101-8643, Japan

    Naoto Setoguchi, Yu Horiuchi, Toshiharu Kawakami, Masaaki Nakase, Yusuke Watanabe, Taiki Ishizawa, Masahiro Sekiguchi, Momoka Nakajima, Hideaki Nonaka, Masahiko Asami, Kazuyuki Yahagi, Kota Komiyama, Hitomi Yuzawa, Jun Tanaka, Jiro Aoki & Kengo Tanabe

  2. Department of Cardiovascular Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-Ku, Tokyo, 113-8654, Japan

    Naoto Setoguchi & Momoka Nakajima

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  1. Naoto Setoguchi
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Correspondence to Yu Horiuchi.

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Conflict of interest

Dr. Tanabe has previously received speaker honoraria from Otsuka Pharmaceutical and Novartis. Dr. Tanaka has previously received speaker honoraria from Otsuka Pharmaceutical and Novartis. Dr. Komiyama has previously received speaker honoraria from Otsuka Pharmaceutical and Novartis. Dr. Yahagi has previously received speaker honoraria from Novartis. Dr. Asami has previously received speaker honoraria from Otsuka Pharmaceutical. Dr. Horiuchi has previously received speaker honoraria from Otsuka Pharmaceutical and Novartis. Dr. Setoguchi has previously received speaker honoraria from Novartis. The remaining authors report no conflicts of interest.

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Setoguchi, N., Horiuchi, Y., Kawakami, T. et al. Diuretic and renal effects of angiotensin receptor-neprilysin inhibitor in patients hospitalized for acute heart failure. Heart Vessels 38, 1042–1048 (2023). https://doi.org/10.1007/s00380-023-02253-w

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  • DOI: https://doi.org/10.1007/s00380-023-02253-w

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