REAL-WORLD RISK OF ACUTE KIDNEY FAILURE AFTER SACUBITRIL/VALSARTAN VS ARB AMONG ADULTS =65 WITH HEART FAILURE
Author(s)
Muhammad Hanif Amiruddin, MBA1, Jason C. Hsu, PhD1, Min-Huei Hsu, PhD2.
1Taipei Medical University, New Taipei City, Taiwan, 2Graduate Institute of Data Science, Taipei Medical University, New Taipei City, Taiwan.
1Taipei Medical University, New Taipei City, Taiwan, 2Graduate Institute of Data Science, Taipei Medical University, New Taipei City, Taiwan.
OBJECTIVES: To compare renal and tolerability outcomes between sacubitril/valsartan and ARB among HF patients aged ≥65 years.
METHODS: Using the TriNetX global federated network, we identified HF patients initiating sacubitril/valsartan (ARNI) or ARB. Patients aged ≥65 years were included, and propensity-score matching (1:1) generated balanced cohorts (n=257,658 per group). Outcomes were Acute Kidney Failure. Kaplan-Meier methods estimated cumulative incidence, and Cox proportional hazards models estimated hazard ratios (HRs). Follow-up extended to 12 months. Covariate balance was excellent (all SMD <0.05)
RESULTS: Median follow-up was 365 days in both groups. Renal outcomes occurred in 19,564 ARNI users and 18,843 ARB users. One-year survival free from outcome was 86.9% for ARNI and 88.0% for ARB. ARNI was associated with a modestly higher risk compared with ARB (HR 1.09; 95% CI 1.07-1.11; p<0.0001). Findings were consistent across Cox model covariates, with expected contributions from chronic kidney disease, older age, elevated BUN, and reduced eGFR. Tolerability patterns aligned with clinical expectations in older HF patients.
CONCLUSIONS: In older adults with HF, sacubitril/valsartan was associated with a slightly higher risk of renal events compared with ARB, although absolute differences were small. These results highlight the importance of individualized therapy and close renal monitoring in this age group. Further studies should clarify mechanisms and evaluate subgroups most at risk.
METHODS: Using the TriNetX global federated network, we identified HF patients initiating sacubitril/valsartan (ARNI) or ARB. Patients aged ≥65 years were included, and propensity-score matching (1:1) generated balanced cohorts (n=257,658 per group). Outcomes were Acute Kidney Failure. Kaplan-Meier methods estimated cumulative incidence, and Cox proportional hazards models estimated hazard ratios (HRs). Follow-up extended to 12 months. Covariate balance was excellent (all SMD <0.05)
RESULTS: Median follow-up was 365 days in both groups. Renal outcomes occurred in 19,564 ARNI users and 18,843 ARB users. One-year survival free from outcome was 86.9% for ARNI and 88.0% for ARB. ARNI was associated with a modestly higher risk compared with ARB (HR 1.09; 95% CI 1.07-1.11; p<0.0001). Findings were consistent across Cox model covariates, with expected contributions from chronic kidney disease, older age, elevated BUN, and reduced eGFR. Tolerability patterns aligned with clinical expectations in older HF patients.
CONCLUSIONS: In older adults with HF, sacubitril/valsartan was associated with a slightly higher risk of renal events compared with ARB, although absolute differences were small. These results highlight the importance of individualized therapy and close renal monitoring in this age group. Further studies should clarify mechanisms and evaluate subgroups most at risk.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD29
Topic
Real World Data & Information Systems
Topic Subcategory
Distributed Data & Research Networks
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Urinary/Kidney Disorders