Early empagliflozin initiation induces diuresis in decompensated HF without worsening kidney function
Germany: A recent study in Circulation revealed that in patients with acute decompensated heart failure, early empagliflozin addition to standard diuretic therapy increases urine output without impacting renal function.
The development of worsening kidney function often limits the effective diuretic regimens using loop diuretics in patients with acute decompensated heart failure. Sodium-glucose cotransporter-2 (SGLT2) inhibitors induce sodium excretion and glucosuria with nephroprotective effects in patients with stable heart failure but there is no clarity on their role in acute decompensated heart failure.
P. Christian Schulze, Department of Internal Medicine, Division of Cardiology, University Hospital Jena, Jena, Germany, and colleagues performed a single-center, prospective, double-blind, placebo-controlled, randomized study -- EMPAG-HF. It included patients with acute decompensated heart failure (n=60). They were randomly assigned to receive empagliflozin 25 mg daily or a placebo in addition to standard decongestive treatments that included loop diuretics.
Cumulative urine output over 5 days was the primary endpoint. Secondary endpoints included dynamics in markers of kidney function and injury, diuretic efficiency, and NT-proBNP (N-terminal pro-B-type natriuretic peptide).
Based on the study, the researchers found the following:
· Addition of empagliflozin daily to standard medical treatment of acute decompensated heart failure resulted in a 25% increase in cumulative urine output over 5 days (median 10.8 versus 8.7 L mL in placebo, group difference estimation 2.2 L).
· Empagliflozin increased diuretic efficiency compared with placebo (14.1 mL urine per milligram furosemide equivalent) without affecting markers of renal function (estimated glomerular filtration rate, 51±19 versus 54±17 mL/min per 1.73 m²) or injury (total urinary protein, 492±845 versus 503±847 mg/g creatinine; and urinary α1-microglobulin, 55.4±38.6 versus 31.3±33.6 mg/g creatinine) with a more pronounced decrease in NT-proBNP in the empagliflozin group compared with placebo (−1861 versus −727.2 pg/mL after 5 days; quotient in slope, 0.89).
· There were no differences in the incidence of safety events between groups.
"In patients with acute decompensated heart failure, the early addition of empagliflozin to standard diuretic therapy increases urine output without affecting renal function," the researchers concluded.
Reference:
The study titled, "Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF)," was published in the journal Circulation.
DOI: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.059038
