In conclusion, we reported the successful use of sacubitril/valsartan in a patient with CRS4 and stage 5 CKD, in which NYHA class IV reduced to NYHA class II, the levels of NT-proBNP, LAD, LVID, and CTR decreased, LVEF increased, blood pressure attenuated, and renal function stable after more than 3 years of follow-up. This evidence concerns the gene NPPB and chronic kidney disease.