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논문분류	춘계학술대회 초록집
제목	Clinical Outcomes Associated with Off-Label Use of Sacubitril/Valsartan in Patients with Heart Failure and End-Stage Kidney Disease: A Real-World Analysis
저자	Ho Sik Shin
출판정보	2026; 2026(1):
키워드	Sacubitril/Valsartan, Heart Failure, ESKD
초록	Objectives: Sacubitril/valsartan is a cornerstone therapy for chronic heart failure with reduced ejection fraction (HFrEF). However, in patients with end-stage kidney disease (ESKD), dose selection in real-world clinical practice is often inconsistent because physicians frequently adjust dosing based on renal function. This study aimed to evaluate the impact of real-world off-label dosing of sacubitril/valsartan on long-term clinical outcomes in patients with heart failure and ESKD. Methods: We analyzed a database of heart failure patients with ESKD treated between 2015 and 2025. Clinical data, including laboratory results, echocardiography, electrocardiography (ECG), and outcomes, were collected. Eligible participants were HF patients with ESKD receiving sacubitril/valsartan therapy. Clinical outcomes—including arrhythmic events, rehospitalization, and cardiovascular events—were compared according to changes in left ventricular ejection fraction (LVEF) during treatment with real-world off-label dosing. Results: A total of 379 patients with HF and ESKD (mean age 75.1 ± 11.9 years) were included. Among them, 240 patients (63.5%) demonstrated improvement in LVEF following sacubitril/valsartan therapy. Baseline characteristics were comparable between groups. During a median follow-up of 24 months, there were no significant differences in arrhythmic events, rehospitalization, or cardiovascular outcomes according to off-label dosing of sacubitril/valsartan (P = 0.609). In multivariate analysis, a lower premature ventricular complex (PVC) burden was independently associated with LVEF improvement (OR 0.950; 95% CI 0.908–0.983; P = 0.032). A PVC burden >2866.5 beats/24 hours predicted decreased LVEF (AUC = 0.752; P = 0.005). Conclusion: Real-world off-label dosing of sacubitril/valsartan was not associated with differences in major clinical outcomes. Instead, a high PVC burden may serve as an independent predictor of worsening cardiac function in HF patients with ESKD.
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