Arshad Muhammad Sameer, Jamil Adeena, Greene Stephen J, Van Spall Harriette G C, Fonarow Gregg C, Butler Javed, Khan Muhammad Shahzeb
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Duke Clinical Research Institute, Durham, NC, USA.
Heart Fail Rev. 2025 Jan;30(1):89-101. doi: 10.1007/s10741-024-10446-2. Epub 2024 Oct 15.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide cardiovascular and kidney benefits to patients with heart failure (HF) and/or chronic kidney disease (CKD), regardless of diabetes status and left ventricular ejection fraction (LVEF). Despite robust data demonstrating the efficacy of SGLT-2 inhibitors in both ambulatory and hospital settings, real-world evidence suggests slow and varied adoption of SGLT2 inhibitors among patients hospitalized for HF. Barriers to implementation of SGLT2i may include clinicians' concerns regarding potential adverse events such as diabetic ketoacidosis (DKA), volume depletion, and symptomatic hypoglycemia; or concerns regarding physiologically expected reductions in eGFR. Guidelines lack specific, practical safety data and definitive recommendations regarding in-hospital initiation and continuation of SGLT2i in patients hospitalized with HF. In this review, we discuss the safety of in-hospital SGLT2 inhibitor initiation based on recent trials and highlight the clinical implications of their early use in patients hospitalized for HF.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂可为心力衰竭（HF）和/或慢性肾脏病（CKD）患者带来心血管和肾脏方面的益处，无论其糖尿病状态及左心室射血分数（LVEF）如何。尽管有大量数据表明SGLT-2抑制剂在门诊和住院环境中均有效，但实际证据显示，因HF住院的患者对SGLT2抑制剂的采用缓慢且存在差异。SGLT2i实施的障碍可能包括临床医生对潜在不良事件（如糖尿病酮症酸中毒（DKA）、容量耗竭和症状性低血糖）的担忧；或对估算肾小球滤过率（eGFR）生理性预期降低的担忧。指南缺乏关于HF住院患者院内启动和继续使用SGLT2i的具体实用安全数据及明确建议。在本综述中，我们根据近期试验讨论院内启动SGLT2抑制剂的安全性，并强调其在HF住院患者中早期使用的临床意义。
