Data_Sheet_1_Application of Angiotensin Receptor–Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus.docx

Chronic kidney disease (CKD) is a global public health problem, and cardiovascular disease is the most common cause of death in patients with CKD. The incidence and prevalence of cardiovascular events during the early stages of CKD increases significantly with a decline in renal function. More than 50% of dialysis patients die from cardiovascular disease, including coronary heart disease, heart failure, arrhythmia, and sudden cardiac death. Therefore, developing effective methods to control risk factors and improve prognosis is the primary focus during the diagnosis and treatment of CKD. For example, the SPRINT study demonstrated that CKD drugs are effective in reducing cardiovascular and cerebrovascular events by controlling blood pressure. Uncontrolled blood pressure not only increases the risk of these events but also accelerates the progression of CKD. A co-crystal complex of sacubitril, which is a neprilysin inhibitor, and valsartan, which is an angiotensin receptor blockade, has the potential to be widely used against CKD. Sacubitril inhibits neprilysin, which further reduces the degradation of natriuretic peptides and enhances the beneficial effects of the natriuretic peptide system. In contrast, valsartan alone can block the angiotensin II-1 (AT1) receptor and therefore inhibit the renin–angiotensin–aldosterone system. These two components can act synergistically to relax blood vessels, prevent and reverse cardiovascular remodeling, and promote natriuresis. Recent studies have repeatedly confirmed that the first and so far the only angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan can reduce blood pressure more effectively than renin–angiotensin system inhibitors and improve the prognosis of heart failure in patients with CKD. Here, we propose clinical recommendations based on an expert consensus to guide ARNI-based therapeutics and reduce the occurrence of cardiovascular events in patients with CKD.

慢性肾脏病（CKD）是全球性的公共卫生问题，而心血管疾病是CKD患者死亡的最常见原因。CKD早期阶段心血管事件的发生率和患病率随着肾功能的下降而显著增加。超过50%的透析患者死于心血管疾病，包括冠心病、心力衰竭、心律失常和猝死。因此，在CKD的诊断和治疗过程中，开发有效的控制风险因素和改善预后的方法成为首要任务。例如，SPRINT研究证实，通过控制血压，CKD药物可以有效降低心血管和脑血管事件。未控制的血压不仅增加了这些事件的风险，还加速了CKD的进展。由恩普利司他（一种神经肽酶抑制剂）和缬沙坦（一种血管紧张素受体阻滞剂）组成的共晶复合物具有在CKD中广泛应用的潜力。恩普利司他通过抑制神经肽酶，进一步减少利钠肽的降解，并增强利钠肽系统的有益作用。相反，单独使用缬沙坦可以阻断血管紧张素II-1（AT1）受体，从而抑制肾素-血管紧张素-醛固酮系统。这两种成分可以协同作用，放松血管，预防和逆转心血管重塑，并促进钠排泄。近期的研究反复证实，目前唯一且第一代的血管紧张素受体-神经肽酶抑制剂（ARNI）沙库巴曲/缬沙坦可以比肾素-血管紧张素系统抑制剂更有效地降低血压，并改善CKD患者心力衰竭的预后。在此，我们基于专家共识提出临床建议，以指导基于ARNI的治疗，并减少CKD患者心血管事件的发生率。