Metabolic Impact of Sacubitril/Valsartan in Diabetic Hemodialysis Patients: Improved Glycoalbumin Without Altering Antidiabetic Therapy

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Metabolic Impact of Sacubitril/Valsartan in Diabetic Hemodialysis Patients: Improved Glycoalbumin Without Altering Antidiabetic Therapy

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Co-author 1

Minako Sakai southchild0830@gmail.com Nagasaki Kidney Center Department of Blood Purification Nagasaki Japan *

Co-author 2

Jyunichiro Hashiguchi hashiguchi1215@gmail.com Nagasaki Kidney Center Department of Blood Purification Nagasaki Japan -

Co-author 3

Kenji Sawase sawakenurouro@yahoo.co.jp Nagasaki Kidney Center Department of Blood Purification Nagasaki Japan -

Co-author 4

Akihiro Maekawa a-maekawa@nagajin.jp Nagasaki Kidney Center Department of Blood Purification Nagasaki Japan -

Co-author 5

Koutaro Shimoyama kaisyokai20@gmail.com Jikei University School of Medicine Department of Nephrology Tokyo Japan -

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Introduction

Sacubitril/valsartan (angiotensin receptor–neprilysin inhibitor; ARNI) is widely recognized for its cardioprotective and antihypertensive properties. Beyond these effects, neprilysin inhibition may preserve incretin-related peptides, such as GLP-1, thereby enhancing insulin sensitivity. However, its metabolic effects in maintenance hemodialysis (HD) patients have not been systematically investigated. In this population, glycoalbumin (GA) serves as a more accurate glycemic marker than HbA1c due to altered erythrocyte lifespan.

Methods

We retrospectively analyzed 9 maintenance HD patients with type 2 diabetes mellitus who received sacubitril/valsartan for ≥9 months without any changes in their antidiabetic medications. GA levels, pre-dialysis blood pressure, and dry weight were evaluated from 2 months before to 6 months after ARNI initiation. Statistical comparisons were performed using the Friedman and Nemenyi tests, and effect sizes were expressed as Kendall’s W.

Results

GA levels showed a significant time-dependent decrease (χ² = 24.16, p = 0.0022; Kendall’s W = 0.33), with consistent downward trends on post hoc analysis. No hypoglycemic episodes or cardiovascular adverse events were observed. Pre-dialysis blood pressure demonstrated mild improvement, while dry weight remained stable throughout the observation period.

Conclusion

This study provides the first evidence that sacubitril/valsartan improves glycemic control, as reflected by GA, in diabetic HD patients without modification of antidiabetic therapy. These findings suggest a potential metabolic benefit of ARNI therapy beyond its established cardiovascular effects, warranting further investigation in larger prospective studies.

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