100 Participants Needed

Sacubitril-Valsartan for Hemodialysis Patients

FR
Overseen ByFinnian R Mc Causland, MBCCh, MMSc
Prior Safety DataThis treatment has passed at least one previous human trial
Approved in 3 JurisdictionsThis treatment is already approved in other countries

What You Need to Know Before You Apply

What is the purpose of this trial?

This randomized placebo-controlled clinical trial will evaluate the effect of sacubitril/valsartan (compared with placebo) on echocardiographic measures of hypervolemia, preservation of residual renal function, and key safety parameters in incident hemodialysis patients.

Will I have to stop taking my current medications?

The trial requires that you have not taken an ACE inhibitor for 36 hours before joining. If you are currently using sacubitril/valsartan, you must stop at least 30 days before participating. Other medications are not specifically mentioned, so it's best to discuss with the trial team.

Is sacubitril-valsartan safe for humans?

Sacubitril-valsartan (Entresto) is generally safe for humans but can cause side effects like low blood pressure, swelling (angioedema), kidney problems, high potassium levels, low sodium levels, and in rare cases, liver injury. It should not be used during pregnancy, breastfeeding, or with certain other medications in people with diabetes.12345

How is the drug sacubitril-valsartan unique for hemodialysis patients?

Sacubitril-valsartan is unique because it combines two components that work together to improve heart function and reduce blood pressure in hemodialysis patients, showing better results than using valsartan alone. It has been shown to improve heart function and reduce symptoms in patients with heart failure and hypertension undergoing dialysis, without causing common side effects like high potassium levels.25678

What data supports the effectiveness of the drug sacubitril-valsartan for hemodialysis patients?

Research shows that sacubitril-valsartan can improve heart function and reduce blood pressure in hemodialysis patients with heart failure, as seen in improvements in heart measurements and symptoms over a 6-month period.25689

Who Is on the Research Team?

FM

Finnian Mc Causland, MBBCh, MMSc

Principal Investigator

Brigham and Women's Hospital

Are You a Good Fit for This Trial?

Adults over 18 who recently started hemodialysis can join this trial. They must have stable blood pressure, not be on certain heart medications, and able to consent. Excluded are those with recent major heart issues, planned transplants, severe liver disease, untreated serious arrhythmias or cancer within the last year.

Inclusion Criteria

I am on a thrice-weekly hemodialysis schedule.
I am 18 or older and started hemodialysis within the last 90 days.
Informed consent
See 2 more

Exclusion Criteria

I am scheduled for a kidney transplant within the next 4 months.
Angioedema related to previous ACE inhibitor, ARB, or ARNI therapy
Serum potassium >5.5 mEq/L at screening (pre-HD if already on HD)
See 18 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive sacubitril/valsartan or placebo, with dose titration over the first 4 weeks and maintenance for 12 weeks

16 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

2 weeks

What Are the Treatments Tested in This Trial?

Interventions

  • Placebo
  • Sacubitril-valsartan
Trial Overview The trial tests if sacubitril-valsartan is better than a placebo for managing fluid overload and preserving kidney function in new hemodialysis patients. It's randomized: participants won't choose which treatment they get.
How Is the Trial Designed?
2Treatment groups
Experimental Treatment
Placebo Group
Group I: sacubitril/valsartanExperimental Treatment1 Intervention
Participants will take sacubitril/valsartan, beginning dose of 24/26mg twice daily, with titration to target dose of 97/103 mg twice daily over the first four weeks. Patients will remain on the maximally tolerated dose for the remaining 12 weeks (total on-drug period of 16 weeks) before stopping drug and being followed for a further two weeks (total study time of 18 weeks).
Group II: placeboPlacebo Group2 Interventions
Participants will take equivalent placebo, beginning equivalent dose of 24/26mg twice daily, with titration to target equivalent dose of 97/103 mg twice daily over the first four weeks. Patients will remain on the maximally tolerated dose for the remaining 12 weeks (total on-drug period of 16 weeks) before stopping drug/placebo and being followed for a further two weeks (total study time of 18 weeks).

Sacubitril-valsartan is already approved in European Union, United States for the following indications:

🇪🇺
Approved in European Union as Entresto for:
  • Heart failure with reduced ejection fraction
🇺🇸
Approved in United States as Entresto for:
  • Chronic heart failure with reduced ejection fraction

Find a Clinic Near You

Who Is Running the Clinical Trial?

Brigham and Women's Hospital

Lead Sponsor

Trials
1,694
Recruited
14,790,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials
2,513
Recruited
4,366,000+

Published Research Related to This Trial

In a study involving male Sprague-Dawley rats with chronic kidney disease, treatment with LCZ696 (sacubitril/valsartan) significantly improved cardiovascular health compared to valsartan alone, showing better outcomes in heart weight, kidney function, and markers of heart stress and inflammation.
LCZ696 was more effective than valsartan in reducing cardiac hypertrophy, fibrosis, and oxidative stress, indicating its potential as a superior treatment for cardiovascular issues associated with chronic kidney disease.
LCZ696 (Sacubitril/Valsartan), an Angiotensin-Receptor Neprilysin Inhibitor, Attenuates Cardiac Hypertrophy, Fibrosis, and Vasculopathy in a Rat Model of Chronic Kidney Disease.Suematsu, Y., Jing, W., Nunes, A., et al.[2023]
In a study of 66 chronic kidney disease (CKD) patients with systolic dysfunction, treatment with sacubitril/valsartan led to a significant improvement in left ventricular ejection fraction (LVEF) from 31% to 39% over 6 months, indicating enhanced heart function.
The treatment was also associated with an initial improvement in renal function after one month, with glomerular filtration rate (GFR) increasing to 53 mL/min/1.73 m², and stability in kidney function was maintained throughout the follow-up period.
Sacubitril/valsartan in chronic kidney disease, the nephrologist point of view.Quiroga, B., de Santos, A., Sapiencia, D., et al.[2021]
In a study of 5 hemodialysis patients, including those with heart failure, switching to sacubitril/valsartan led to significant improvements in blood pressure post-dialysis and heart function over a 6-month period, with no reported side effects.
NT-pro-BNP levels decreased significantly, indicating improved heart function, and echocardiography showed a reduction in left atrial size and an increase in left ventricular ejection fraction, demonstrating the efficacy of sacubitril/valsartan in managing hypertension and heart failure in these patients.
Functional changes in the heart after sacubitril/valsartan use in 5 hemodialysis patients with hypertension. Case report.Kuwae, N.[2023]

Citations

LCZ696 (Sacubitril/Valsartan), an Angiotensin-Receptor Neprilysin Inhibitor, Attenuates Cardiac Hypertrophy, Fibrosis, and Vasculopathy in a Rat Model of Chronic Kidney Disease. [2023]
Sacubitril/valsartan in chronic kidney disease, the nephrologist point of view. [2021]
Functional changes in the heart after sacubitril/valsartan use in 5 hemodialysis patients with hypertension. Case report. [2023]
Effects of sacubitril-valsartan in the treatment of chronic heart failure patients with end-stage renal disease undergoing dialysis. [2023]
Sacubitril/valsartan in heart failure and end-stage renal insufficiency. [2021]
[Angiotensin-receptor- and neprilysin-inhibition: a new option against heart failure]. [2021]
Sacubitril/Valsartan (Entresto®)-Induced Hyponatremia. [2021]
Sacubitril/valsartan-induced liver injury: A case report and literature review. [2023]
Pharmacokinetics and pharmacodynamics of sacubitril/valsartan in peritoneal dialysis patients. [2023]
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