Abstract: TH-PO0093
SGLT2 Inhibitors and Moderate-to-Severe Hypomagnesemia in Heart Failure: A Real-World Cohort Study
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical Research
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Shah, Chintan Vimalkumar, University of Florida College of Medicine, Gainesville, Florida, United States
- He, Ruina, University of Florida College of Medicine, Gainesville, Florida, United States
- Alli, Abdel A., University of Florida College of Medicine, Gainesville, Florida, United States
- Kazory, Amir, University of Florida College of Medicine, Gainesville, Florida, United States
Background
Hypomagnesemia is common in patients with heart failure (HF). Sodium-glucose cotransporter-2 (SGLT2) inhibitors, a key component of guideline-directed medical therapy, have been shown to increase serum magnesium (S.Mg) levels in certain case series and modestly increase S. Mg in various secondary analyses of randomized trials. Here, we examined the association between SGLT2 inhibitor initiation and moderate-to-severe hypomagnesemia in HF with and without diabetes.
Methods
We conducted a single-center retrospective cohort study at the University of Florida that included adults with chronic HF who newly initiated and continued SGLT2 inhibitors for ≥6 months between 2016 and 2023. Moderate-to-severe hypomagnesemia (S. Mg ≤1.4 mg/dL) was assessed during the 12 months before and after the index prescription, with patients stratified a priori according to diabetes status. The pre-specified primary analysis used McNemar's test in the overall cohort and within each diabetes stratum. Subsequently, a post-hoc multivariable logistic regression and between-stratum absolute and relative risk comparisons were performed.
Results
The cohort comprised 106 HF patients (56 with diabetes, 50 without diabetes; 43.5% with reduced ejection fraction). The mean age was 59 years, and 54% were men. Following initiation of SGLT2 inhibitors, the prevalence of moderate-to-severe hypomagnesemia declined from 40.6% to 21.7% in the overall cohort (absolute reduction [AR], 18.9%; p=0.002).In the pre-specified diabetes-stratified analysis, the prevalence declined from 39.3% to 19.6% among patients with diabetes (AR of 19.7%, p=0.010) and from 42.0% to 24.0% among patients without diabetes (AR of 18.0%, p=0.081). In the post-hoc multivariable model, diabetes was not independently associated with post-intervention hypomagnesemia (adjusted OR 0.9; 95% CI, 0.3–2.9). The between-stratum absolute risk difference was −4.4% (95% CI, −20.1 to 11.4).
Conclusion
Among patients with HF, initiation of an SGLT2 inhibitor was associated with a substantial reduction in moderate-to-severe hypomagnesemia in the overall cohort, with effects of comparable magnitude in patients with and without diabetes. If confirmed in larger prospective studies, these results may broaden the therapeutic implications of SGLT2 inhibitors beyond their current cardiorenal applications.
Funding
- Other NIH Support