A retrospective single-centre cohort study published in Clinical Cardiology evaluated 360 adults with heart failure with reduced ejection fraction (left ventricular ejection fraction <40%) and predialysis stage 3–4 chronic kidney disease who initiated sacubitril/valsartan between 2017 and 2023 and were followed for up to 24 months. The study was designed to be descriptive rather than comparative. The primary renal composite included sustained ≥30% estimated glomerular filtration rate decline, chronic dialysis, or end-stage kidney disease, with death treated as a competing event.

Among survivors, mean estimated glomerular filtration rate remained stable, with no creatinine rise, while N-terminal pro-B-type natriuretic peptide and C-reactive protein decreased (both P<.001) and New York Heart Association class improved. The renal composite occurred in 12 of 360 patients (3.3%), while…