Patients with heart failure with reduced ejection fraction (HFrEF) and severe kidney impairment, with an estimated glomerular filtration rate (eGFR) below 30 ml/min/1.73 m², often face limited therapeutic options. A study published at European Society of Cardiology Congress 2025 highlighted data assessing the safety and efficacy of sacubitril/valsartan in this population.

This systematic review and meta-analysis included 9,464 patients from 10 studies, of which two were randomized controlled trials. Follow-up ranged from six to 27 months, with a mean patient age of 65.4 ± 3.8 years. Sacubitril/valsartan significantly reduced all-cause mortality by 41% (risk ratio [RR] 0.59, 95% confidence interval [CI] 0.36–0.96, p<0.01) and hospitalizations by 41% (RR 0.59, 95% CI 0.36–0.96, p<0.01).

The effect on overall cardiovascular events was inconclusive (RR 0.84, 95% CI 0.54–1.30, p=0.12). No significant increase in adverse events was observed compared with standard therapy.

These findings suggest that sacubitril/valsartan provides meaningful clinical benefit in patients with HFrEF and severely reduced kidney function. Further high-quality randomized trials are required to confirm these results and establish long-term safety in this vulnerable population.