Dapagliflozin reduces risk for hyperkalemia in HFrEF patients treated with MRAs: Study

Hyperkalaemia often limits the use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure and reduced ejection fraction (HFrEF), denying these patients a life-saving therapy. HFrEF is a complex clinical syndrome characterized by structural and/or functional impairment of the left ventricle, resulting in a decrease in heart pump function.

A study was conducted by Kristensen S et. al to determine whether treatment with the sodium-glucose cotransporter 2 (SGLT-2) inhibitor dapagliflozin reduces the risk of hyperkalaemia associated with MRA use in patients with HFrEF.

The researchers examined the risk of developing mild hyperkalaemia (potassium > 5.5 mmol/L) and moderate/severe hyperkalaemia (>6.0 mmol/L) in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) according to background mineralocorticoid receptor antagonist (MRA) use, and randomized treatment assignment, by use of Cox regression analyses.

The results of the study are as follows:

• Overall, 3370 (70.1%) patients in Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) were treated with a mineralocorticoid receptor antagonist (MRA).
• Mild hyperkalaemia and moderate/severe hyperkalaemia occurred in 182 (11.1%) and 23 (1.4%) patients treated with dapagliflozin as compared to 204 (12.6%) and 40 (2.4%) of patients given a placebo.
• This yielded a hazard ratio (HR) of 0.86 for mild hyperkalaemia and 0.50 for moderate/severe hyperkalaemia, comparing dapagliflozin to placebo.

The researchers concluded that patients with Heart Failure and reduced ejection fraction (HFrEF) and taking a mineralocorticoid receptor antagonist (MRA) who were randomized to dapagliflozin had half the incidence of moderate/severe hyperkalaemia, compared with those randomized to placebo.

Reference

A study titled, "Dapagliflozin reduces the risk of hyperkalaemia in patients with heart failure and reduced ejection fraction": a secondary analysis DAPA-HF by Kristensen S et. al published at European Society of Cardiology virtual congress.

https://esc365.escardio.org/Congress/215836-dapagliflozin-reduces-the-risk-of-hyperkalaemia-in-patients-with-heart-failure-and-reduced-ejection-fraction-a-secondary-analysis-dapa-hf