Dapagliflozin in Patients With Heart Failure and Deterioration in Renal Function (JACC November 2023-1)-Article: Dapalgliflozin in Patients With Heart Failure and Deterioration in Renal Function

Article: Dapalgliflozin in Patients With Heart Failure and Deterioration in Renal Function

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The study investigates the effects of dapagliflozin, an SGLT2 inhibitor, in heart failure (HF) patients who experience renal function deterioration, specifically when estimated glomerular filtration rate (eGFR) drops below 25 mL/min/1.73 m². SGLT2 inhibitors are recommended in HF management, even for those with chronic kidney disease (CKD), but their safety and efficacy in cases where eGFR falls significantly are uncertain.<br /><br />Using a pooled analysis of 11,007 patients from the DAPA-HF and DELIVER trials, the study evaluates the outcomes of continuing dapagliflozin under these conditions. Among the patients, 347 (3.2%) experienced an eGFR decline to 25 mL/min/1.73 m² at least once during follow-up. These patients exhibited a higher risk of adverse cardiovascular events, yet the study found that dapagliflozin reduced the primary composite outcome (cardiovascular death or worsening HF) compared to placebo, regardless of whether the patients’ eGFR declined.<br /><br />The incidence rate of the primary outcome was significantly lower for those treated with dapagliflozin (HR: 0.53) compared to placebo (HR: 0.78). Safety outcomes, including drug discontinuation rates, were similar between the two treatment groups. The study suggests that the benefits of continuing dapagliflozin in HF patients with declining kidney function outweigh the risks, supporting its use even when eGFR falls below the regulatory threshold for initiation (25 mL/min/1.73 m²).<br /><br />The findings highlight the importance of continuing dapagliflozin treatment in managing HF, despite renal function deterioration, given its efficacy in reducing cardiovascular risks without increasing adverse events. However, the study is careful to note that these conclusions support continuation rather than new initiation of the therapy at advanced stages of CKD, and call for further randomized controlled trials to solidify these findings.

Keywords

dapagliflozin

SGLT2 inhibitor

heart failure

renal function

eGFR

chronic kidney disease

DAPA-HF

DELIVER trials

cardiovascular events

safety and efficacy