Key result
The addition of dapagliflozin within 24 hours of admission for acute decompensated heart failure did not significantly affect the incidence of worsening renal function compared to loop diuretics alone (16.1% vs 12.1%, p=0.54).
Why the study?
Dapagliflozin reduces cardiovascular mortality in chronic heart failure, but its impact on worsening renal function when added to standard decongestive therapy with loop diuretics needed evaluation.
Does the addition of dapagliflozin to loop diuretics reduce the incidence of worsening renal function in patients with acute decompensated heart failure?
RCT (n=114)
Open-label
1:1
No
Does the addition of dapagliflozin to loop diuretics reduce the incidence of worsening renal function in patients with acute decompensated heart failure?
Absolute Event Rate: 16.1% vs 12.1%
p-value: p=0.54
Early initiation of dapagliflozin in acute decompensated heart failure safely reduces the required dose of loop diuretics without increasing the risk of worsening renal function.
AIMS: Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 inhibitor, has been shown to reduce cardiovascular mortality among patients with chronic heart failure. We aimed to evaluate the impact on a worsening renal function (WRF) by adding DAPA as compared to standard decongestive therapy with loop diuretics alone. METHODS AND RESULTS: We enrolled 114 consecutive acute decompensated heart failure (ADHF) patients with a left ventricular ejection fraction (LVEF) of less than 50%. The patients were prospectively randomized to be assigned either to DAPA group who received DAPA at a dose of 10 mg once daily within 24 h after admission or conventional therapy group (CON group) who received loop diuretics alone. All patients were adjusted by increasing or decreasing the loop diuretic by 10 mg to maintain a 1-2 mL/kg/h urine output. The primary endpoint was the incidence of WRF, which was defined as an increase in the serum creatinine of ≥0.3 mg/dL from baseline. The median age of the patients was 77 [interquartile range (IQR): 64, 85] years, 35% were female and the median LVEF was 33 [IQR: 28, 38] %. There was no significant difference in the incidence of WRF between the two groups (16.1%, n = 9 vs. 12.1%, n = 7, P value = 0.54). The total dose of loop diuretics through day 7 was lower in the DAPA group than CON group (184 ± 79.5 mg vs. 214 ± 66.5 mg, P value = 0.03). CONCLUSIONS: This randomized prospective trial revealed the addition of DAPA within 24 h after admission reduced the diuretic dose without WRF.
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Kawanami et al. (2025) conducted an RCT in Acute decompensated heart failure (ADHF) (n=114). Dapagliflozin vs. Conventional therapy (loop diuretics alone) was evaluated on Incidence of worsening renal function (increase in serum creatinine of ≥0.3 mg/dL from baseline within 7 days) (p=0.54). The addition of dapagliflozin within 24 hours of admission for acute decompensated heart failure did not significantly affect the incidence of worsening renal function compared to loop diuretics alone (16.1% vs 12.1%, p=0.54).
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