Kawanami Shodai, Egami Yasuyuki, Abe Masaru, Osuga Mizuki, Nohara Hiroaki, Ukita Kohei, Kawamura Akito, Yasumoto Koji, Okamoto Naotaka, Matsunaga-Lee Yasuharu, Yano Masamichi, Nishino Masami
Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
ESC Heart Fail. 2025 Jun;12(3):2023-2033. doi: 10.1002/ehf2.15212. Epub 2025 Jan 31.
Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 inhibitor, has been shown to reduce cardiovascular mortality among patients with chronic heart failure. We aimed to evaluate the impact on a worsening renal function (WRF) by adding DAPA as compared to standard decongestive therapy with loop diuretics alone.
We enrolled 114 consecutive acute decompensated heart failure (ADHF) patients with a left ventricular ejection fraction (LVEF) of less than 50%. The patients were prospectively randomized to be assigned either to DAPA group who received DAPA at a dose of 10 mg once daily within 24 h after admission or conventional therapy group (CON group) who received loop diuretics alone. All patients were adjusted by increasing or decreasing the loop diuretic by 10 mg to maintain a 1-2 mL/kg/h urine output. The primary endpoint was the incidence of WRF, which was defined as an increase in the serum creatinine of ≥0.3 mg/dL from baseline. The median age of the patients was 77 [interquartile range (IQR): 64, 85] years, 35% were female and the median LVEF was 33 [IQR: 28, 38] %. There was no significant difference in the incidence of WRF between the two groups (16.1%, n = 9 vs. 12.1%, n = 7, P value = 0.54). The total dose of loop diuretics through day 7 was lower in the DAPA group than CON group (184 ± 79.5 mg vs. 214 ± 66.5 mg, P value = 0.03).
This randomized prospective trial revealed the addition of DAPA within 24 h after admission reduced the diuretic dose without WRF.
达格列净（DAPA）是一种钠-葡萄糖协同转运蛋白2抑制剂，已被证明可降低慢性心力衰竭患者的心血管死亡率。我们旨在评估与单独使用襻利尿剂的标准消肿治疗相比，加用DAPA对肾功能恶化（WRF）的影响。
我们纳入了114例连续的急性失代偿性心力衰竭（ADHF）患者，其左心室射血分数（LVEF）小于50%。患者被前瞻性随机分为DAPA组，在入院后24小时内接受每日一次10毫克剂量的DAPA治疗，或传统治疗组（CON组），仅接受襻利尿剂治疗。所有患者通过增加或减少10毫克襻利尿剂进行调整，以维持1-2毫升/千克/小时的尿量。主要终点是WRF的发生率，定义为血清肌酐较基线水平升高≥0.3毫克/分升。患者的中位年龄为77岁[四分位间距（IQR）：64，85]，35%为女性，中位LVEF为33%[IQR：28，38]。两组之间WRF的发生率没有显著差异（16.1%，n = 9 vs. 12.1%，n = 7，P值 = 0.54）。DAPA组至第7天的襻利尿剂总剂量低于CON组（184±79.5毫克 vs. 214±66.5毫克，P值 = 0.03）。
这项随机前瞻性试验表明，入院后24小时内加用DAPA可降低利尿剂剂量且不会导致WRF。
