Key result
SGLT2i introduction in HFrEF is linked to increased renal resistance index, with early worsening in ~13%.
Why the study?
The mechanisms underlying the cardiorenal protection of SGLT2 inhibitors in HFrEF patients, particularly their effects on eGFR and renal resistance index, require evaluation.
Does SGLT2i introduction alter eGFR and arterial renal resistance index in outpatients with HFrEF?
Observational (n=52)
Does SGLT2i introduction alter eGFR and arterial renal resistance index in outpatients with HFrEF?
In patients with HFrEF, introduction of SGLT2 inhibitors is associated with a significant early increase in the renal resistance index regardless of early worsening of renal function, reflecting potential modulation of afferent arteriole tone and glomerular hyperfiltration.
Background Type 2 sodium glucose cotransporter inhibitors (SGLT2i) have demonstrated cardiorenal protection in patients affected by type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD) and chronic heart failure (CHF). Among the mechanisms underlying this benefit, there is the possible restoration of tubuloglomerular, which contrasts glomerular hyperfiltration and the progression of CKD. Aim of the study. To evaluate the relationship between the introduction of SGLT2i, the estimated glomerular filtration rate (eGFR) and the arterial renal resistance index (RRI) in CHF outpatients with reduced ejection fraction (HFrEF). Methods Fifty–two patients (mean age 60±13, 81% males, NYHA class 2.2±0.39, 21% with T2DM and 31% with CKD) affected by HFrEF (mean left ventricular ejection fraction, LVEF, 31±7%) and in conventional therapy (100% ACE–inhibitors or ATII receptor antagonists or sacubitril/valsartan, 100% beta–blockers, 86% mineralcorticoid receptor antagonists) were enrolled. Before and 1 or 3, 6, 12, and 24 months after SGLT2i prescription, eGFR by serum creatinine levels and the renal resistance index (RRI) by echo Doppler were evaluated. Changes in the repeated measures were evaluated by linear mixed models. A p<0.05 was considered significant. Results In comparison with baseline values, a non–significant reduction in eGFR but a significant increase in RRI values was observed at 1–3, 6 and 12 months (see Figure panels A and B). During early follow–up, 13% of patients showed early worsening of renal function (WRF, defined as an increase of serum creatinine > 0.3 mg/dl with an eGFR reduction >25%). Among patients with and without WRF, eGFR diverged, whereas a similar trend in change of RRI was observed. Conclusions In HFrEF patients, after SGLT2i introduction a significant increase in RRI observed in patients with and without early WRF. These data strengthen the possible effects of SGLT2i on afferent arterioles and hyperfiltration, considering that afferent and efferent arterioles are mainly responsible for renal resistance variations.
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Biancofiore et al. (2026) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=52). Type 2 sodium glucose cotransporter inhibitors (SGLT2i) vs. Baseline (before SGLT2i prescription) was evaluated on Changes in estimated glomerular filtration rate (eGFR) and arterial renal resistance index (RRI). SGLT2i introduction in HFrEF outpatients significantly increased renal resistance index across the cohort, while early worsening of renal function occurred in 13% of patients.
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