Low dose sacubitril/valsartan is effective and safe in hemodialysis patient with decompensated heart failure and hypotension

Low dose sacubitril/valsartan is effective and safe in hemodialysis patient with decompensated heart failure and hypotension

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Abstract.Rationale:.Severe 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 concerns:.This case was a 67 year old lady with decompensated heart failure and hypotension who was on a pea in the pod nursing bra regular HD.

Intensified hemofiltration failed to improve her heart failure symptoms and was also retarded by hypotension.Diagnosis:.Chronic HD with decompensated heart failure.

Interventions:.In addition to regular HD, low does sacubitril/valsartan was initiated and titrated from 12/13 mg to 24/26 mg twice daily.Outcomes:.

Sacubitril/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 ultra max dog shampoo has improved from New York Heart Association class 4 to class 2.

Lessons:.Low does ARNI treatment could effectively improve cardiac function in HD patients with heart failure and hypotension.It was also safe and well tolerated.