Purpose of the study: сomparative study of the effect of ARNI (combination of valsartan and sacubitrile) on the structural and functional state of the kidneys in patients with IHD after revascularization.

Material and research methods. The study included 320 patients with coronary artery disease. 37 patients underwent surgical revascularization (CABG), 283 patients underwent endovascular revascularization. On average, the concentration of creatinine was 90.08 ± 1.72 µmol /l.  All patients were divided into 2 groups: patients who received the drug valsartan (group B, 160 people), patients who received a combination of valsartan and sacubitril a (ARNI - a combination of a molecule of valsartan and an inhibitor of neprilysin sacubitril in a molar ratio of 1: 1) (group C, 160 people). Also, all patients were divided into 2 subgroups depending on the degree of eGFR decrease by the 3rd month of observation: patients with a decrease in eGFR by the 3rd month of observation more than 20% (group 1 - 59 patients) and less than 20% (group 2 - 261 sick). In dynamics, three months later, at the end of the first and second years of follow-up after revascularization, the patients underwent determination of the blood creatinine concentration, with the calculation of GFR and ultrasound examination (US) of the kidneys with dopplerography of the segmental arteries.

Research results. The study showed that during 2 years of follow-up after coronary revascularization, there was a decrease in eGFR in both groups of patients, regardless of the therapy. Comparative analysis of the dynamics of eGFR between patients with different treatment regimens, depending on the severity of the decrease in eGFR, showed that the dynamics of the progression of CKD was significantly greater in patients with decreased eGFR by the 3rd month of therapy by 20% or more compared with patients who received sacubitril in the therapy regimen.The difference becomes significant only by the 1st year of observation and persists by the 2nd year of observation. Resistivity index of renal segmental arteries by the end of observation in-group C was significantly (p <0.05) lower than in-group B.

Conclusion. The inclusion of ARNI (a combination of valsartan and sacubitril) in the IHD treatment regimen contributes to a significant decrease in the rate of progression of CKD in patients prone to rapid progression of type II cardiorenal syndrome. Against the background of ARNI application, there was a tendency to slow down the progression of pathological renal glomerular vascular remodeling.

Ischemic heart disease, chronic kidney disease, ARNI

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Enterd 09.12. 2020