Short Term Renal Safety of Dapagliflozin in Heart Failure Patients with Chronic Kidney Disease and/Or Diabetes

Abstract

Background:  Heart failure is complex clinical syndrome that can result from any anatomical or functional cardiac disease that decreases the ability of the ventricle to fill or eject blood. More than half of heart failure patients may have moderate to severe renal insufficiency. The presence of chronic kidney disease in a patient with heart failure is associated with increased morbidity and mortality in these patients. Dapagliflozin is a selective and reversible inhibitor of Sodium-glucose co-transporter-2 (SGLT2)  The majority of the advantages of SGLT2 inhibitors in heart failure are linked to reduced salt reabsorption in the renal tubule, increased natriuresis and osmotic diuresis, lower plasma volume and blood pressure, improved cardiac energy metabolism, inflammation reduction, sympathetic nervous system inhibition, and prevention of adverse cardiac remodeling,  Objective: To evaluate the safety and efficacy of additional dapagliflozin into conventional therapy on Renal function in heart failure patients. Patients and Methods: This was prospective clinical study conducted at medical wards at Nasiriya Heart Center during the period from the 1st of November / 2021 to the end of July / 2022. The study included 120 patients with heart failure with renal insufficiency. The patients were divided into two groups, first group consisted of 60 patients who received dapagliflozin in addition to conventional therapy and the other group consisted of 60 patients who received only conventional therapy. Both groups were matched Socio demographic data. Renal function test, hemoglobin concentration, blood pressure, ejection fraction, body mass index were recorded on day 1 as a baseline visit then followed up after four months. Results: Before treatment there was no significant difference in sociodermographic and clinical parameters between two groups   After treatment, Patients in the dapagliflozin group had significantly lower mean levels of BMI, serum creatinine, systolic and diastolic blood pressure compared with control group (BMI; 25.98 kg/m2 vs 27.53 kg/m2, P= 0.035), (serum creatinine; 1.32 mg/dl vs 1.79 mg/dl, P= 0.043), (systolic blood pressure; 109.4 mmHg vs 121.6 mmHg, P= 0.005), and (diastolic blood pressure; 67.16 mmHg vs 75.62 mmHg, P= 0.002). Further, hemoglobin and GFR levels were significantly increased in the dapagliflozin group than in the control group (12.53 g/L vs 11.88 g/L, P= 0.038) and (58.02 vs 54.12, P= 0.023), respectively. No significant difference was detected in blood urea and ejection fraction levels between the two groups. Conclusion: The study shows clinical and biochemical benefit from the addition of dapagliflozin tconventional therapy where dapagliflozin resulted in significant lower rate of decline decline eGFR anreduce the progression of kidney disease compared to the control group.