Abstract: SA-PO498
Empagliflozin in Patients with Acute Heart Failure and Diuretic Resistance: Preliminary Data from the DRIP-AHF-1 Trial
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Marques, Pedro, McGill University Health Centre, Montreal, Quebec, Canada
- Sharma, Abhinav, McGill University Health Centre, Montreal, Quebec, Canada
- Mavrakanas, Thomas, McGill University Health Centre, Montreal, Quebec, Canada
Background
Diuretic resistance is common in acute heart failure and associated with poor clinical outcomes. Chronic kidney disease (CKD) is a major determinant of diuretic resistance. Association of furosemide with sodium-glucose cotransporter 2 inhibitors can potentially overcome diuretic resistance in acute heart failure patients with CKD.
Methods
This is a prospective, single-arm, observational, open-label clinical trial. Patients admitted with acute heart failure with estimated glomerular filtration rate (eGFR) of 15-45mL/min/1.73m2 and diuretic resistance, defined as a urinary output (UO)<300mL in the 2 hours post 1-1.5mg/kg IV furosemide, were recruited. These patients received 25mg of empagliflozin 2 hours post a second IV furosemide bolus of 1-1.5mg/kg, administered at least 5 hours after the initial furosemide bolus.
Primary outcome is the 3-hour UO post furosemide+empagliflozin on the first day of the study, compared with furosemide alone. Secondary outcomes include fractional excretion of sodium (FENa) and total urinary sodium excretion.
Results
From 32 patients screened, 6 patients met inclusion criteria and consented to participate. Median age was 80 (75-84) years, 67% were male, median ejection fraction was 40 (40-55) % and median baseline eGFR 18 (17-25) mL/min/1.73m2. All patients had a strong response to furosemide after empagliflozin administration (Table)
Conclusion
Our preliminary data shows that empagliflozin at a dose of 25mg, when added to high dose IV furosemide in patients with acute heart failure, low eGFR and diuretic resistance, is capable of increasing urinary output and urinary sodium excretion.
Data for the primary and secondary outcomes
| Patient number | UO 3h post FST (mL) | UO 3h post Empa+FST (mL) | FENa 3h post FST (%) | FENa 3h post Empa+FST (%) | Na excretion 3h post FST (mmol) | Na excretion 3h post Empa+FST (mmol) |
| #1 | 215 | 290 | 4.7 | 7.6 | 14.4 | 22.0 |
| #2 | 345 | 650 | 2.3 | 8.5 | 19.7 | 57.9 |
| #3 | 290 | 515 | 7.2 | 11.3 | 27.8 | 55.6 |
| #4 | 490 | 775 | 8.0 | 11.4 | 54.8 | 88.4 |
| #5 | 80 | 310 | 3.3 | 6.4 | 6.0 | 27.0 |
| #6 | 340 | 605 | 5.0 | 12.4 | 30.9 | 67.8 |
Empa - Empagliflozin; FENa - Fractional excretion of sodium; FST - Furosemide stress test; Na - Sodium; UO - Urinary output
Funding
- Private Foundation Support