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Impact of dapagliflozin treatment on renal function and diuretics use in acute heart failure: a pilot study
Kristina Charaya1, Dmitry Shchekochikhin2, Denis Andreev2
1Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation charaya9716@gmail.com.
Objective:
To determine the impact of sodium-dependent glucose type 2 cotransporter inhibitors on the renal function in acute heart failure.
Methods:
In a single-centre, controlled, randomised study, patients were prescribed dapagliflozin in addition to standard therapy, or were in receipt of standard therapy. The prespecified outcome was renal function deterioration; the secondary outcomes were the development of resistance to diuretics, weight loss, death during hospitalisation and the rehospitalisation or death for any reason within 30 days following discharge.
Results:
102 patients were included (73.4±11.7 years, 57.8% men). The average left ventricular ejection fraction was 44.9%±14.7%, the average N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was 4706 (1757; 11 244) pg/mL, the average estimated glomerular filtration rate (eGFR) was 51.6±19.5 mL/min. eGFR decreased 48 hours after randomisation in the dapagliflozin group (-4.2 (-11.03; 2.28) mL/min vs 0.3 (-6; 6) mL/min; p=0.04) but did not differ between the groups on discharge (54.71±19.18 mL/min and 58.92±24.65 mL/min; p=0.36). The incidence of worsening renal function did not differ (34.4% vs 15.2%; p=0.07). In the dapagliflozin group, there was less tendency to increase the dose of loop diuretics (14% vs 30%; p=0.048), lower average doses of loop diuretics (78.46±38.95 mg/day vs 102.82±31.26 mg/day; p=0.001) and more significant weight loss (4100 (2950; 5750) g vs 3000 (1380; 4650) g; p=0.02). In-hospital mortality was 7.8% (4(8%) in the dapagliflozin and 4 (7.7%) in the control group (p=0.95). The number of deaths within 30 days following discharge in the dapagliflozin group and in the control group was 9 (19%) and 12 (25%), p=0.55; the number of rehospitalisations was 14 (29%) and 17 (35%), respectively (p=0.51).
Conclusion:
The use of dapagliflozin was associated with a more pronounced weight loss and less need to increase diuretic therapy without significant deterioration of the renal function. Dapagliflozin did not improve the in-hospital and 30-day prognosis after discharge.
Trial Registration Number:
N04778787.
Insights
Sodium-glucose cotransporter 2 inhibitors like dapagliflozin aid weight loss and reduce diuretic needs in acute heart failure patients. However, dapagliflozin did not significantly impact renal function or improve short-term prognosis in this study.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Acute heart failure (AHF) presents complex management challenges, often involving renal function and fluid overload.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly explored for cardiovascular benefits beyond diabetes.
Purpose of the Study:
- To evaluate the effect of dapagliflozin, an SGLT2 inhibitor, on renal function in patients with acute heart failure.
- To assess secondary outcomes including diuretic resistance, weight loss, and short-term mortality.
Main Methods:
- A single-center, randomized controlled trial involving 102 patients with acute heart failure.
- Patients received either standard therapy or standard therapy plus dapagliflozin.
- Primary endpoint was renal function deterioration; secondary endpoints included diuretic resistance, weight loss, and mortality.
Main Results:
- While estimated glomerular filtration rate (eGFR) showed a transient decrease at 48 hours in the dapagliflozin group, renal function did not differ significantly at discharge.
- The incidence of worsening renal function was not significantly different between groups (34.4% vs 15.2%, p=0.07).
- Dapagliflozin use was associated with less need for increased diuretic doses (p=0.048), lower average diuretic doses (p=0.001), and greater weight loss (p=0.02).
Conclusions:
- Dapagliflozin administration in acute heart failure patients led to significant weight loss and reduced diuretic requirements without causing significant renal function deterioration.
- The study did not demonstrate an improvement in in-hospital or 30-day post-discharge prognosis with dapagliflozin use.
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