Empagliflozin plus loop diuretics significantly increase urine volume in diabetes with HF

UK: The use of SGLT2 inhibitor empagliflozin in combination with loop diuretics in patients with type 2 diabetes (T2D) and heart failure, helps in significant increase in urine volume, show findings from RECEDE-CHF trial. Also, it caused a significant weight loss, significant increase in electrolyte-free water clearance and reduced requirement for loop diuretic.

SGLT2 (sodium-glucose cotransporter-2) inhibitors are known to improve heart failure associated outcomes in T2D patients. Given the recent FDA approval for dapagliflozin use in HF patients with reduced ejection fraction, improvement in HF-associated outcomes seen with SGLT2 inhibitors, the coprescription of SGLT2 inhibitors and loop diuretic will become common. Considering this, there arises a need for future mechanistic studies to understand their combined effects.

The aim of the study, published in the journal Circulation, conducted by Chim C. Lang, University of Dundee, Scotland, United Kingdom, and colleagues, is to explore the effects of the SGLT2 inhibitor empagliflozin on diuresis and natriuresis and on the interaction between loop diuretics and SGLT2 inhibitors.

The RECEDE-CHF trial (SGLT2 Inhibition in Combination With Diuretics in Heart Failure) is a randomized, double-blind, placebo-controlled, crossover trial. It included 23 participants with type 2 diabetes and heart failure with reduced ejection fraction who were regular loop diuretic. The patients were randomized to empagliflozin 25 mg once daily or placebo for 6 weeks with a 2-week washout period. The primary outcome was change in 24-hour urinary volume from baseline to week 6.