Sacubitril/Valsartan is well tolerated in patients with HF and renal disorders: TRANSITION Study
- Ms. Reddy Francy Priyanka
- Sep 9
- 3 min read
Updated: Sep 10
Patients with coexisting heart failure (HF) and renal dysfunction (RD) face a significantly poorer prognosis compared to those with HF alone, experiencing higher rates of hospitalization, mortality, and morbidity. Managing patients with heart failure with reduced ejection fraction (HFrEF) and renal dysfunction (RD) is challenging due to the risk of further worsening of kidney function, particularly following an episode of acute decompensated heart failure (ADHF). Initiating and optimizing HF therapies in these patients is particularly difficult due to altered pharmacokinetics and pharmacodynamics of HF medications (1). Hence, it is crucial to explore new therapeutic strategies specifically tailored for patients with heart failure and impaired renal function.
In recent years, sacubitril/valsartan has emerged as a promising therapeutic option for heart failure. It is an angiotensin receptor-neprilysin inhibitor with dual effects on the renin-angiotensin system (RAS) and the natriuretic peptide system (1).
Cardio–renal benefits of Sacubitril/Valsartan
Sacubitril/valsartan provides several cardio–renal benefits. It improves renal function, reverses cardiac remodelling (2), and leads to notable improvements in eGFR and cardiac biomarkers (1). It also improves quality of life (2) and has a favourable safety profile compared to ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) (2). Furthermore, sacubitril/valsartan reduces natriuretic peptide levels and lowers the risk of HF rehospitalization or cardiovascular death in stabilised HFrEF patients after an episode of ADHF (3).
A meta-analysis showed that in patients with heart failure and chronic kidney disease, sacubitril/valsartan significantly improved eGFR while reducing blood pressure and NT-proBNP levels (4). Nonetheless, data on the tolerability and feasibility of early initiation and up-titration of sacubitril/valsartan in HFrEF patients with renal dysfunction hospitalized for ADHF remain scarce (1). The TRANSITION study was designed to address this important clinical question.
Study Summary
Conclusion
The TRANSITION study evaluated the impact of renal dysfunction on the initiation, up-titration, and tolerability of sacubitril/valsartan in haemodynamically stabilised patients with heart failure with reduced ejection fraction (HFrEF) following hospitalisation for acute decompensated heart failure (ADHF). Early initiation of sacubitril/valsartan in patients with HFrEF and concomitant renal dysfunction was generally well tolerated, leading to significant improvements in renal function and cardiac biomarkers.
About the Author
Reddy Francy Priyanka, holds an MSc in Biotechnology. She is passionate about medical writing and enjoys transforming complex research into clear, concise narratives that empower informed healthcare decisions. Priyanka has been working as a freelance medical writer and has experience in handling medico-marketing communication.
Abbreviations
Renal dysfunction was defined as an eGFR (using the MDRD formula) ≥30 to <60 mL/min/1.73 m² determined at randomization; BD: twice daily; CI: confidence interval; eGFR: estimated glomerular filtration rate; HF: heart failure; HFrEF: heart failure with reduced ejection fraction; ADHF: Acute Decompensated Heart Failure; hsTnT: high-sensitivity troponin T; LSM: least squares mean; NT-proBNP: N-terminal prohormone of brain natriuretic peptide; RD: renal dysfunction; Aes: adverse events;
References
Straburzynska-Migaj, Ewa et al. Early Initiation of Sacubitril/Valsartan in Patients with Acute Heart Failure and Renal Dysfunction: An Analysis of the TRANSITION Study. Journal of cardiac failure vol. 30,3 (2024): 425-435.
Zhang, Rui et al. The Efficacy and Safety of Sacubitril/Valsartan in Heart Failure Patients: A Review. Journal of cardiovascular pharmacology and therapeutics vol. 27 (2022): 10742484211058681.
Berg, David D et al. Efficacy and Safety of Sacubitril/Valsartan by Dose Level Achieved in the PIONEER-HF Trial. JACC. Heart failure vol. 8,10 (2020): 834-843.
Kang, Huaning et al. Effects of sacubitril/valsartan in patients with heart failure and chronic kidney disease: A meta-analysis. European journal of pharmacology vol. 884 (2020): 173444.
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