Couto Pereira, Sara CristinaRodrigues, TiagoFerreira, Afonso NunesAgostinho, João R.Pinto, Fausto J.Brito, Dulce2023-02-222023-02-222023Pereira, S.C., et al. J. Clin. Med. 2023, 12, 1334http://hdl.handle.net/10451/56406© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Background: data regarding the effectiveness and safety of sacubitril/valsartan in heart failure and reduced ejection fraction (HFrEF) patients with chronic kidney disease (CKD) are scarse. Objective: to evaluate the effectiveness and safety of sacubitril/valsartan in HFrEF and CKD in a real-world population. Methods: we included consecutive ambulatory HFrEF patients that initiated sacubitril/valsartan between February 2017 and October 2020, stratified by CKD (KDIGO stage 5 excluded). Primary outcomes: the incidence rate per 100 patient-years and the annualized length of stay (LOS) of acute decompensated HF hospitalizations (HFH). Secondary outcomes: all-cause mortality, NYHA improvement, and titration of sacubitril/valsartan. Results: We included 179 patients, 77 with CKD, those being older (72 ± 10 vs. 65 ± 12 years, p < 0.001), had higher NT-proBNP (4623 ± 5266 vs. 1901 ± 1835 pg/mL, p < 0.001), and high anaemia incidence (p < 0.001). After 19 ± 11 months, a significant reduction in HFH adjusted incidence rate (57.5% decrease in CKD vs. 74.6%, p = 0.261) was observed, with 5 days there was a reduction in annualized LOS in both groups (p = 0.319). NYHA improved similarly in both groups (p = 0.670). CKD patients presented non-significant higher all-cause mortality (HR = 2.405, 95%CI: [0.841; 6.879], p = 0.102). Both groups had similar sacubitril/valsartan maximum dose achievement and drug withdrawal. Conclusion: sacubitril/valsartan was effective on reducing HFH and LOS without affecting all-cause mortality in a CKD real-world population.engChronic kidney diseaseGlomerular filtration rateHeart failure with reduced ejection fractionAngiotensin receptor neprilysin inhibitorSacubitrilValsartanjournal article10.3390/jcm120413342077-0383