Heart failure & cardiomyopathiesRandomised controlled trial
Water Conservation Overrides Osmotic Diuresis During SGLT2 Inhibition in Patients With Heart Failure
- Randomised controlled trial
- single-centre
- double-blind
- placebo-controlled
Authors' 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
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 volume — Dapagliflozin vs Placebo · early | 2.8 (−1.97 to 7.48) | P = 0.25 | |
| Urine volume — Dapagliflozin vs Placebo · late | 0.9 (−3.83 to 5.62) | P = 0.70 | |
| −50510Difference, mL/kg/d (linear scale) |
| Outcome | Estimate | P value |
|---|---|---|
| Urine glucose excretion — Dapagliflozin vs Placebo · early (within 48 h) | 3.3 mmol/kg/d (95% CI 2.51–4.04) | P < 0.0001 |
| Urine glucose excretion — Dapagliflozin vs Placebo · late (4 weeks) | 2.7 mmol/kg/d (95% CI 1.98–3.51) | P < 0.0001 |
| Serum copeptin — Dapagliflozin vs Placebo · early | 5.5 pmol/L (95% CI 0.45–10.5) | P < 0.05 |
| Serum copeptin — Dapagliflozin vs Placebo · late | 7.8 pmol/L (95% CI 2.77–12.81) | P < 0.01 |
| Free water clearance — Dapagliflozin vs Placebo · early | −9.1 mL/kg/d (95% CI −14 to −4.12) | P < 0.001 |
| Free water clearance — Dapagliflozin 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:10.1016/j.jacc.2024.02.020
Summarised from the published abstract; every number is checked against it