Ilkun O, Kazory A. Breaking barriers: Neprilysin inhibition in chronic cardiorenal syndrome. World J Cardiol 2025; 17(7): 107539 [DOI: 10.4330/wjc.v17.i7.107539]
Corresponding Author of This Article
Amir Kazory, Professor, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, 1600 Sw Archer Rd Box 100224, Gainesville, FL 32610, United States. amir.kazory@medicine.ufl.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Jul 26, 2025; 17(7): 107539 Published online Jul 26, 2025. doi: 10.4330/wjc.v17.i7.107539
Breaking barriers: Neprilysin inhibition in chronic cardiorenal syndrome
Olesya Ilkun, Amir Kazory
Olesya Ilkun, Amir Kazory, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL 32610, United States
Author contributions: Both Ilkun O and Kazory A searched the literature, designed, wrote, edited, and revised the manuscript; Kazory A submitted the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amir Kazory, Professor, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, 1600 Sw Archer Rd Box 100224, Gainesville, FL 32610, United States. amir.kazory@medicine.ufl.edu
Received: March 26, 2025 Revised: April 29, 2025 Accepted: June 16, 2025 Published online: July 26, 2025 Processing time: 119 Days and 0.3 Hours
Abstract
Over the last decade, neprilysin inhibition has been established as the cornerstone of therapy in heart failure (HF). Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) have a high prevalence of HF; the concomitant presence of HF and CKD or ESKD, conventionally termed chronic cardiorenal syndrome, is associated with a higher rate of adverse outcomes, including increased hospitalizations and mortality. The use of this novel class of medications in patients with advanced CKD or ESKD has been limited due to uncertainty about their efficacy and safety. Herein, we provide an overview of the available evidence on the use of neprilysin inhibition in HF and discuss how those concepts would apply to patients with concomitant CKD or ESKD.
Core Tip: Patients with advanced chronic kidney disease and end-stage kidney disease face disproportionally high rates of heart failure and mortality. Currently, there is an unmet need for medical therapies for heart failure in these populations. This review summarizes information regarding the safety and efficacy of the use of angiotensin receptor/neprilysin inhibition in patients with heart failure with reduced ejection fraction and advanced chronic kidney disease or end-stage kidney disease to help guide safe clinical management.
