Impact of Angiotensin Receptor-Neprilysin Inhibition Combined with Enteral Nutritional Therapy on Cardiac Performance and Inflammatory Burden in Hemodialysis-Associated Heart Failure: Clinical and Experimental Evidence

作者：Liu X, Lu T, Hu Q, Yang C · 发表于：Malawi medical journal : the journal of Medical Association of Malawi · 年份：2026 · DOI：10.4314/mmj.v38i2.6 · 被引用次数：33 · 研究领域：Heart Failure、Enteral Nutrition、Aminobutyrates、Neprilysin、Renal Dialysis、Angiotensin Receptor Antagonists、Tetrazoles、Humans、Male、Biphenyl Compounds、Valsartan、Female

BACKGROUND: Cardiovascular complications remain the leading cause of mortality in patients undergoing maintenance hemodialysis (MHD), with heart failure (HF) representing a major clinical challenge. Beyond neurohormonal dysregulation, malnutrition and chronic microinflammation contribute significantly to disease progression. This study investigated whether angiotensin receptor-neprilysin inhibition combined with enteral nutritional support could provide additive benefits in this high-risk population. METHODS: A randomized controlled clinical study was conducted involving 60 MHD patients with HF, allocated to standard therapy or combined intervention groups. The intervention consisted of sacubitril/valsartan administration together with structured enteral nutrition support. Cardiac structure and function, inflammatory markers, nutritional indices, immune parameters, and quality-of-life scores were evaluated over 6 months. In parallel, a rat model of post-infarction HF was established to validate mechanistic and physiological changes, including echocardiographic measurements and serum biomarker assessment. RESULTS: Patients receiving the combined regimen demonstrated superior improvement in left ventricular systolic performance, with greater reductions in LV dimensions and circulating BNP levels compared with conventional treatment. Inflammatory mediators including IL-1β, IL-6, and CRP were significantly attenuated, while serum albumin, total protein, hemoglobin, and immunogl...