Effects of sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, on renal impairment in patients with cyanotic congenital heart disease.

Sacubitril/valsartan (angiotensin receptor-neprilysin inhibitor [ARNI]) is widely used to manage heart failure, a common complication in patients with cyanotic congenital heart disease (CCHD). Its effects on the kidneys, especially in patients with long-standing cyanosis, remain poorly understood. We report three cases of CCHD who were started on ARNI for ventricular dysfunction. During treatment, all three developed features of cyanotic nephropathy. The discontinuation of ARNI led to a gradual improvement in renal function in all cases. This highlights a possible correlation between the use of ARNI and compromised renal parameters in patients with CCHD. Further studies are necessary to evaluate the renal safety and long-term effects of ARNI therapy.