EFFECT OF SGLT2 INHIBITOR DAPAGLIFLOZIN ON SODIUM, POTASSIUM AND CREATININE LEVELS IN PATIENTS WITH ACUTE HEART FAILURE
DOI:
https://doi.org/10.55519/JAMC-S4-11906Keywords:
Dapagliflozin; serum electrolytes; acute heart failure; serum creatinine.Abstract
Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) is a new class of medication for the treatment of type 2 diabetes mellitus. Additionally, they have been found to have beneficial effects on heart failure outcomes, convincingly reducing the morbidity and mortality in heart failure. Although the medical data indicates SGLT2i to be safe and cardio-protective, very little attention has been given to the impact of these agents on electrolyte balance particularly in acute heart failure (AHF). We aimed to evaluate the effect of SGLT2i, and dapagliflozin on serum sodium, potassium and creatinine in AHF. Methods: Overall, 160 adult patients of either gender, admitted with AHF were selected for the study. Selected individuals were randomly assigned to receive dapagliflozin 10 mg orally added to standard medical treatment (n=80) or were in reception of standard medical therapy only (n=80). Serum electrolytes and serum creatinine were collected on admission and day 7 or on discharge whichever happened earlier. Results: The mean level of serum electrolytes displayed insignificant differences among both groups on admission. The mean level of serum potassium was higher in the dapagliflozin group compared with the control group (p<0.001) on day 7/discharge. Mean serum sodium level was comparable and showed significant differences between the two groups following treatment (p-value=0.021). Significant higher levels of serum creatinine were observed following treatment in both groups. However, on intergroup comparison, they were statistically insignificant. Conclusion: Dapagliflozin is an effective treatment of heart failure and is not associated with deterioration of serum electrolyte levels and renal functioning when used as add-on therapy in AHF.References
Arrigo M, Jessup M, Mullens W, Reza N, Shah AM, Sliwa K, et al. Acute heart failure. Nat Rev Dis Primers 2020;6(1):16.
Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, et al. The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology. Euor J Heart Fail 2019;21(2):137–55.
Shah H, Salahudin M, Jan MU, Altaf AJJ. Comparing the sodium excreting efficacy of furosemide and indapamide combination against furosemide and metolazone combination in congestive heart failure patients: A randomized control trial. J Pak Med Assoc 2019;69(12):1794–9.
Ter Maaten JM, Valente MA, Damman K, Hillege HL, Navis G, Voors A. Diuretic response in acute heart failure—pathophysiology, evaluation, and therapy. Am Heart J 2015;12(3):184–92.
Butler J, Usman MS, Khan MS, Greene SJ, Friede T, Vaduganathan M, et al. Efficacy and safety of SGLT2 inhibitors in heart failure: systematic review and meta-analysis. ESC Heart Fail 2020;7(6):3298–309.
Biegus J, Voors AA, Collins SP, Kosiborod MN, Teerlink JR, Angermann CE, et al. Impact of empagliflozin on decongestion in acute heart failure: the EMPULSE trial. Eur Heart J 2023:44(1):41–50.
Matsumura K, Sugiura TJ. Effect of sodium glucose cotransporter 2 inhibitors on cardiac function and cardiovascular outcome: a systematic review. Cardiovasc Ultrasound 2019;17(1):26.
Garg V, Verma S, Connelly K. Mechanistic insights regarding the role of SGLT2 inhibitors and GLP1 agonist drugs on cardiovascular disease in diabetes. Prog Cardiovasc Dis 2019;62(4):349–57.
Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020;22(8):1342–56.
Ibrahim A, Ghaleb R, Mansour H, Hanafy A, Mahmoud NM, Abdelfatah Elsharef M, et al. Safety and Efficacy of Adding Dapagliflozin to Furosemide in Type 2 Diabetic Patients with Decompensated Heart Failure and Reduced Ejection Fraction. Front Cardiovasc Med 2020;7:602251.
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Euro Heart J 2021;42(36):3599–726.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120(4):c179–c84.
Felker GM, Ellison DH, Mullens W, Cox ZL, Testani J. Diuretic therapy for patients with heart failure: JACC state-of-the-art review. J Am Coll Cardiol 2020;75(10):1178–95.
Brisco‐Bacik MA, Ter Maaten JM, Houser SR, Vedage NA, Rao V, Ahmad T, et al. Outcomes associated with a strategy of adjuvant metolazone or high‐dose loop diuretics in acute decompensated heart failure: a propensity analysis. J Am Heart Assoc 2018;7(18):e009149.
Wilcox CS, Shen W, Boulton DW, Leslie BR, Griffen SC. Interaction Between the Sodium‐Glucose–Linked Transporter 2 Inhibitor Dapagliflozin and the Loop Diuretic Bumetanide in Normal Human Subjects. J Am Heart Assoc 2018;7(4):e007046.
Nakagaito M, Joho S, Ushijima R, Nakamura M, Kinugawa KJ. Comparison of canagliflozin, dapagliflozin and empagliflozin added to heart failure treatment in decompensated heart failure patients with type 2 diabetes mellitus. Circ Rep 2019;1(10):405–13.
Voors AA, Damman K, Teerlink JR, Angermann CE, Collins SP, Kosiborod M, et al. Renal effects of empagliflozin in patients hospitalized for acute heart failure: from the EMPULSE trial. Eur J Heart Fail 2022;24(10):1844–52.
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