Physicians' Academy for Cardiovascular Education

Early ARNI treatment initiation after acute decompensated HF well tolerated in HFrEF patients with CKD

News - June 30, 2021

Initiation of sacubitril/valsartan in patients with renal impairment early after acute decompensated heart failure in the TRANSITION study

Presented at the ESC HF 2021 by Ewa Straburzynska-Migaj (Poznan, Poland)

Introduction and methods

Many patients with HF also have CKD. These patients have a higher risk of adverse outcomes during the vulnerable phase after acute decompensated HF episodes and up-titration of HF treatment can be challenging.

The TRANSITION study was an open-label, randomized study that compared early initiation and up-titration of sacubitril/valsartan treatment with post-discharge initiation of sacubitril/valsartan after acute decompensated HF in stabilized patients with HFrEF. This post hoc analysis of TRANSITION assessed the up-titration success and tolerability of early initiation of sacubitril/valsartan in patients with HFrEF with or without CKD (CKD group n=476; non-CKD group n=483). The primary endpoint was achieving target dose of sacubitril/valsartan (97/103 mg) twice daily at 10 weeks post-randomization. CKD was defined as eGFR of ≥30 to <60 mL/min/1.73m².



This post hoc analysis of the TRANSITION study showed that early initiation and up-titration of sacubitril/valsartan after decompensated HF was well tolerated in patients with CKD. However, patients with CKD were more susceptible to hyperkalemia and renal impairment and may require slower up-titration during the vulnerable post-discharge phase.

–Our coverage of ESC HF 2021 is based on the information provided during the congress –

Share this page with your colleagues and friends: