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Effects of angiotensin receptor neprilysin inhibitor on renal function in patients with heart failure: a systematic review and meta-analysis
  1. Yuwu Shi1,
  2. Yiwen Wang2,
  3. Junhong Chen2,
  4. Chi Lu1,
  5. Haochen Xuan2,
  6. Chaofan Wang2,
  7. Dongye Li1,2,
  8. Tongda Xu2
  1. 1Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
  2. 2Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
  1. Correspondence to Dr Dongye Li, Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China, postal code: 221008; dongyeli{at}


The angiotensin receptor neprilysin inhibitor (ARNI) has been recommended as a first-line treatment in patients with heart failure (HF). However, the effects of ARNI on renal function remain controversial.

The PubMed, Embase, the Cochrane Library of Trials and Web of Science were searched in the period from inception to 31 January 2021. Randomised controlled trial, cohort studies and observational studies reporting at least one of renal function indicators were included.

In patients with HF with reduced ejection fraction (HFrEF), ARNI did not lead to a significant decrease in estimated glomerular filtration rate (eGFR, p=0.87), and the risk of worsening renal function (WRF) dropped by 11% compared with control group. Though the level of serum creatinine (SCr) and serum potassium had a slight increase (p=0.01; p=0.02), in contrast to the baseline level, but without clinical significance. In patients with HF with preserved ejection fraction (HFpEF), the level of SCr and serum potassium did not have a significant change, and patients with HFpEF assigned to ARNI had a much lower rate of WRF (p=0.0007). In contrast to control group, both patients with HFrEF and HFpEF had a less decrease in eGFR and a lower rate of hyperkalaemia in ARNI group.

ARNI did not lead to a significant decrease in eGFR in HFrEF. Compared with control group, ARNI could delay the progression of decrease in eGFR and result in less events of hyperkalaemia in patients with HF. Besides, patients with HFpEF had a lower rate in the events of WRF.

  • heart failure

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  • Contributors YS and YW were mainly responsible for literature screening, data extraction and manuscript writing. HX, CW and CL were responsible for data processing. JC, TX and DL contributed to designing this study and revising the manuscript.

  • Funding This work was supported by the Key Research Developmental Programme of Jiangsu Province (social development, no. BE2019639) and The Project for Jiangsu Provincial Administration of Traditional Chinese Medicine (YB201988).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.