Heart failure & cardiomyopathies
Water Conservation Overrides Osmotic Diuresis During SGLT2 Inhibition in Patients With Heart Failure
An erratum to this article was published (J Am Coll Cardiol, 25 Jun 2024 ↗)
Primary result · Urine concentrationResult — go to the resultEstimate 134 mmol/L 95% CI 39.28–229.12Authors' conclusion
Physiological-adaptive water conservation eliminated the expected osmotic diuretic potential of dapagliflozin and thereby prevented a glucose-driven increase in urine volume of approximately 10 mL/kg/d · 75 kg = 750 mL/kg/d.
Study context
- Population
- Chronic HF, NYHA class I/II, reduced EF, SGLT2 inhibitor-naïve33 completed
- Participants
- 15 vs 14
- Comparison
- Dapagliflozin vs placebo
- Dapagliflozinn = 15
- Placebon = 14reference
- Primary endpoint
- Change from baseline in urine osmolyte concentration
Methodological detailssingle-centre, double-blind, placebo-controlled
- Single-centre
- Double-blind
- Placebo-controlled
Primary result
Urine concentration · 4 weeks (late)
Estimate
134 mmol/L
95% CI 39.28–229.12
P < 0.01
As reported in the abstract
Secondary outcomes
| Outcome | Mean difference (mL/kg/d) (95% CI) | P value | |
|---|---|---|---|
| Urine volumeDapagliflozinvs PlaceboEarly | 2.8 (−1.97 to 7.48) | P = 0.25 | |
| Urine volumeDapagliflozinvs PlaceboLate | 0.9 (−3.83 to 5.62) | P = 0.70 | |
| −50510Difference, mL/kg/d (linear scale) |
| Outcome | Estimate | P value |
|---|---|---|
| Urine glucose excretionDapagliflozin vs Placebo · early (within 48 h) | 3.3 mmol/kg/d (95% CI 2.51–4.04) | P < 0.0001 |
| Urine glucose excretionDapagliflozin vs Placebo · late (4 weeks) | 2.7 mmol/kg/d (95% CI 1.98–3.51) | P < 0.0001 |
| Serum copeptinDapagliflozin vs Placebo · early | 5.5 pmol/L (95% CI 0.45–10.5) | P < 0.05 |
| Serum copeptinDapagliflozin vs Placebo · late | 7.8 pmol/L (95% CI 2.77–12.81) | P < 0.01 |
| Free water clearanceDapagliflozin vs Placebo · early | −9.1 mL/kg/d (95% CI −14 to −4.12) | P < 0.001 |
| Free water clearanceDapagliflozin vs Placebo · late | −11.0 mL/kg/d (95% CI −15.94 to −6.07) | P < 0.0001 |
Original publication
Water Conservation Overrides Osmotic Diuresis During SGLT2 Inhibition in Patients With Heart Failure. J Am Coll Cardiol. Published 16 April 2024. doi:10.
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