• Yunlin Feng, Wenhua Li, Hongjun Liu, and Xiuling Chen.
• Nephrology Department, Sichuan Provincial People's Hospital, Chengdu, China.
• Medicine (Baltimore). 2022 Apr 15; 101 (15): e29186e29186.

RationaleSevere heart failure in chronic hemodialysis (HD) patients is a great treatment challenge. Here we reported a chronic HD patient with the lowest ejection fraction reported so far and hypotension who well tolerated and benefited from angiotensin-receptor neprilysin inhibitor (ARNI) treatment.Patient ConcernsThis case was a 67 year old lady with decompensated heart failure and hypotension who was on regular HD. Intensified hemofiltration failed to improve her heart failure symptoms and was also retarded by hypotension.DiagnosisChronic HD with decompensated heart failure.InterventionsIn addition to regular HD, low does sacubitril/valsartan was initiated and titrated from 12/13 mg to 24/26 mg twice daily.OutcomesSacubitril/valsartan treatment was well tolerated and did not affect ultrafiltration during HD treatment. Transthoracic echocardiology at 3 months after initiation of ARNI treatment indicated significant improvement of both systolic and diastolic cardiac function. The patient has improved from New York Heart Association class 4 to class 2.LessonsLow does ARNI treatment could effectively improve cardiac function in HD patients with heart failure and hypotension. It was also safe and well tolerated.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

19 keywords...

hide…