Renal Effects of SGLT2 Inhibitors in Patients With Acute Heart Failure

In patients with heart failure, sodium-glucose cotransporter-2 (SGLT2) inhibitors improve renal and cardiovascular outcomes. There is growing evidence that SGLT2 inhibition decreases the risk of acute kidney injury (AKI). Jananya Wattanakul and colleagues, of the Bhumibol Adulyadej Hospital, Bangkok, Thailand, conducted a study to examine the effect of SGLT2 inhibitors on biomarkers of tubular injury in patients with acute heart failure.

Results of the study were reported during a poster session at the American Society of Nephrology Kidney Week 2023. The poster was titled SGLT2 Inhibitor Dapagliflozin Reduces Biomarkers of Tubular Injury in Patients With Acute Heart Failure.

The study cohort included patients who were hospitalized for acute heart failure. Patients were randomized to receive dapagliflozin added to standard therapy or to a control group for 28 days. The primary outcome of interest was the change of urinary biomarkers ([TIMP-2] × [IGFBP7]) by NephroCheck from baseline. Secondary outcomes included the incidence of AKI, change in serum creatinine from baseline, adverse events (AEs), and 28-day mortality.

Thirty-two patients underwent randomization. After 7 days, compared with the control group, dapagliflozin significantly reduced urinary biomarkers ([TIMP-2] × [IGFBP7]): dapagliflozin, –0.03 (ng/mL)² per 1000 versus control, +0.04 (ng/mL)² per 1000; P=.022. The trend continued to the end of the study period.

Compared with the control group, there was a trend toward a decrease in AKI events in the dapagliflozin group (33.3% vs 46.2%; P=.0513). The two groups were similar in change in serum creatinine, AEs, and 28-day mortality.

“Initiation of SGLT2 inhibitors in patients with acute heart failure significantly decreased the urinary AKI risk markers TIMP-2 and IGFBP7 and supported the protective effect of SGLT2 inhibitors on renal tubular injury,” the researchers said.

Source: Wattanakul J, Gojaseni P, Chittinandana A. SGLT2 inhibitor dapagliflozin reduces biomarkers of tubular injury in patients with acute heart failure. TH-PO059. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania.