{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:57:07Z","timestamp":1790582227232,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stage 3\u20134 chronic kidney disease (CKD) is common in heart failure with reduced ejection fraction (HFrEF) but remains underrepresented in angiotensin receptor\u2013neprilysin inhibitor (ARNI) trials, fostering reluctance to initiate sacubitril\/valsartan (S\/V).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis<\/jats:title>\n                    <jats:p>We hypothesized that, over 24 months, S\/V would be associated with stable renal function and acceptable clinical outcomes; the study was designed to be descriptive rather than comparative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 360 adults with HFrEF (LVEF\u2009&lt;\u200940%) and predialysis stage 3\u20134 CKD who initiated S\/V (2017\u20132023) and were followed for up to 24 months; decedents were analyzed as events, not excluded. The primary renal composite (sustained \u2265\u200930% eGFR decline, chronic dialysis, or end\u2010stage kidney disease) was analyzed with competing\u2010risk methods (Aalen\u2013Johansen and Fine\u2013Gray, with death competing); mortality with Cox regression; longitudinal eGFR with mixed\u2010effects; and sparse\u2010event models with Firth penalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among survivors, mean eGFR was stable (mixed\u2010model slope non\u2010significant), with no creatinine rise; NT\u2010proBNP and CRP fell (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and NYHA class improved. The renal composite occurred in 12\/360 (3.3%); all\u2010cause and cardiovascular mortality were 6.1% and 3.9%. Lower baseline eGFR was associated with the renal composite. Analyzes of maintenance dose and concomitant SGLT2\u2010inhibitor use were confounded by treatment tolerance and calendar era and were hypothesis\u2010generating only.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single\u2010arm cohort of HFrEF with stage 3\u20134 CKD, S\/V was generally well tolerated, with stable renal function and low event rates over 24 months. These descriptive, hypothesis\u2010generating findings cannot establish comparative benefit and require confirmation in controlled studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70473","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:22:17Z","timestamp":1790166137000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Renal Function and Clinical Outcomes of Sacubitril\/Valsartan in HFrEF and Stage 3\u20134 Chronic Kidney Disease: A 24\u2010Month Single\u2010Centre Cohort"],"prefix":"10.1002","volume":"49","author":[{"given":"Fatih","family":"Akkaya","sequence":"first","affiliation":[{"name":"Department of Cardiology Ordu University Faculty of Medicine Ordu Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5164-8312","authenticated-orcid":false,"given":"Onur Osman","family":"\u015eeker","sequence":"additional","affiliation":[{"name":"Department of Cardiology Samsun Education and Research Hospital Samsun Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5445-4735","authenticated-orcid":false,"given":"Ercan","family":"T\u00fcrkmen","sequence":"additional","affiliation":[{"name":"Department of Nephrology Ondokuz Mayis University Faculty of Medicine Samsun Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0090-3835","authenticated-orcid":false,"given":"Se\u00e7kin","family":"Dereli","sequence":"additional","affiliation":[{"name":"Department of Cardiology Ordu University Faculty of Medicine Ordu Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13002"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.02.004"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfaf224"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hft052"},{"issue":"1","key":"e_1_2_12_6_1","first-page":"202","article-title":"Treatment of Chronic Heart Failure in Advanced Chronic Kidney Disease: The HAKA Multicenter Retrospective Real\u2010World Study","volume":"14","author":"Quiroga B.","year":"2024","journal-title":"Cardiorenal Medicine"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad195"},{"issue":"18","key":"e_1_2_12_8_1","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich P. 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Angiotensin\u2010Converting Enzyme Inhibitors\/Angiotensin Receptor Blockers in Patients With Reduced Ejection Fraction Combined With Moderate\u2010to\u2010Severe Chronic Kidney Disease","volume":"29","author":"Zhang Z.","year":"2024","journal-title":"Journal of Cardiovascular Pharmacology and Therapeutics"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13313"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.24085"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-01759-5"},{"key":"e_1_2_12_30_1","volume-title":"Mayo Clinic Proceedings","author":"Chang H.\u2010Y.","year":"2023"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2471"},{"issue":"2","key":"e_1_2_12_32_1","first-page":"1","article-title":"Albumin, an Interesting and Functionally Diverse Protein, Varies From \u2018Native\u2019 to \u2018Effective\u2019","volume":"29","author":"Wu 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