From the FDA Drug Label
Closely monitor serum creatinine, and down-titrate or interrupt sacubitril and valsartan in patients who develop a clinically significant decrease in renal function Monitor serum potassium periodically and treat appropriately, especially in patients with risk factors for hyperkalemia such as severe renal impairment, diabetes, hypoaldosteronism, or a high potassium diet.
The recommended frequency of blood work monitoring for kidney function, specifically Blood Urea Nitrogen (BUN) and potassium levels, in patients taking Entresto (sacubitril/valsartan) is not explicitly stated in the FDA drug label. However, it is recommended to closely monitor serum creatinine and monitor serum potassium periodically.
- Key factors to consider when monitoring include:
- Patients with risk factors for hyperkalemia, such as severe renal impairment, diabetes, hypoaldosteronism, or a high potassium diet.
- Patients who develop a clinically significant decrease in renal function. 1
From the Research
Monitoring kidney function and electrolytes is essential when taking Entresto (sacubitril/valsartan), with blood work checked before starting, within 1-2 weeks after initiation, and again after 4 weeks, then every 3-6 months or more frequently if needed, focusing on BUN, creatinine, eGFR, and potassium levels, as supported by the most recent study 2. When considering the management of patients on Entresto, it's crucial to prioritize the monitoring of kidney function and electrolyte levels to prevent potential complications such as hyperkalemia or a decline in kidney function.
- Key parameters to monitor include:
- Blood Urea Nitrogen (BUN)
- Creatinine
- Estimated Glomerular Filtration Rate (eGFR)
- Potassium levels Given the potential of Entresto to cause hyperkalemia, close monitoring of potassium levels is particularly important, with a threshold of 5.5 mEq/L for consideration of dose adjustment or temporary discontinuation, as indicated by previous studies 3, 4. The frequency of monitoring should be tailored to the individual patient's risk factors and clinical status, with more frequent checks for those with pre-existing kidney impairment, diabetes, or concomitant use of medications that may affect kidney function, such as NSAIDs, as suggested by earlier research 5, 6. Staying well-hydrated and maintaining a balanced diet with careful management of potassium intake can also help in maintaining stable kidney function while on Entresto therapy, as generally recommended in the management of patients with kidney disease. Overall, the approach to monitoring should be guided by the most recent and highest quality evidence available, with an emphasis on preventing morbidity, mortality, and preserving quality of life for patients on Entresto, as supported by the latest study on the protective effects of sacubitril/valsartan on kidney function 2.