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However, its benefits in patients with concomitant kidney failure undergoing replacement therapy remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Using the National Health Insurance Service database, we identified individuals with HFrEF and kidney failure receiving replacement therapy who were prescribed either ARNI or renin-angiotensin system (RAS) blockers between 2017 and 2021. After applying inverse probability of treatment weighting, we compared 2104 patients on ARNI with 2191 on RAS blockers. The primary endpoint was a composite of all-cause mortality and any hospitalization. Secondary endpoints included all-cause mortality, any hospitalization and cardiovascular mortality. During a median follow-up of 19.1 months, ARNI use was associated with a significantly lower risk of the primary endpoint (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.75\u20130.97) compared with RAS blockers. ARNI also showed a reduced risk of all-cause mortality (HR 0.68, 95% CI 0.54\u20130.86), any hospitalization (HR 0.86, 95% CI 0.75\u20130.98) and cardiovascular mortality (HR 0.68, 95% CI 0.52\u20130.89). Subgroup analyses demonstrated consistent associations across age, sex, comorbidities and medications. Good adherence to ARNI was linked to a lower risk of the primary outcome, whereas non-adherence showed no benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among HFrEF patients with kidney failure receiving replacement therapy, ARNI use was associated with lower risks of all-cause mortality, any hospitalization and cardiovascular mortality compared with RAS blockers, particularly in those with good adherence to therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15359","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T10:33:24Z","timestamp":1751538804000},"page":"3405-3415","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Angiotensin Receptor-Neprilysin Inhibitors in Concurrent Heart Failure with Reduced Ejection Fraction and Kidney Failure"],"prefix":"10.1093","volume":"12","author":[{"given":"Mi-Hyang","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, College of Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, The Catholic University of Korea , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Hyuk","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, Korea University Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimi","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Endocrinology and Metabolism, Korea University Medicine , Seoul ,","place":["Republic of 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Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0998-503X","authenticated-orcid":false,"given":"Jong-Chan","family":"Youn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, College of Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, The Catholic University of Korea , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Su","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, Yonsei University, Wonju College of Medicine , Wonju ,","place":["Republic of 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