Marked reduction in serum uric acid levels after empagliflozin initiation in a patient with heart failure

Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce serum uric acid levels through enhanced urinary excretion; however, individual responses vary. We report the case of a man in his late 60s with heart failure with reduced ejection fraction who experienced a marked reduction in serum uric acid to 3 mg/dL after the initiation of empagliflozin 10 mg daily. This reduction was accompanied by an increase in the fractional excretion of uric acid from 2.89% to 6.59%. Uric acid reduction was sustained during follow-up without clinically relevant adverse events and the patient remained clinically stable. Background urate-lowering therapy remained unchanged before and throughout SGLT2 inhibitor treatment, and no changes were made to concomitant medications during follow-up. SGLT2 inhibitor use may lead to a substantial reduction in serum uric acid levels in select patients and enhanced urinary uric acid excretion may contribute to this effect.