Kidney Week

Abstract: SA-PO0481

Patient-Reported Outcomes from a Randomized Clinical Trial of SGLT2 Inhibitors in Heart Failure-Associated AKI

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Aklilu, Abinet Mathias, Yale School of Medicine, New Haven, Connecticut, United States

Abinet Mathias Aklilu, MD, MPH

• Reed, Abigail, Yale School of Medicine, New Haven, Connecticut, United States

Abigail Reed

• Shelton, Kyra A., Yale School of Medicine, New Haven, Connecticut, United States

Kyra A. Shelton

• Victoria Castro, Angela Maria, Yale School of Medicine, New Haven, Connecticut, United States

Angela Maria Victoria Castro, MD, MS

• Testani, Jeffrey M., Yale School of Medicine, New Haven, Connecticut, United States

Jeffrey M. Testani, MD

• Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States

Francis Perry Wilson, MD, MS

Group or Team Name

• Clinical and Translational Research Accelerator

Background

The effect of SGLT2i initiation during AKI on heart failure (HF) symptoms is unknown. AKI is often a barrier to SGLT2i initiation during acute HF admissions where these drugs have otherwise shown benefit.

Methods

This is a parallel group RCT of dapagliflozin vs usual care (UC) in hospitalized adults with HF-associated AKI (NCT#06111768) conducted at a single tertiary care center. Those with stable or improving renal function, alternative cause of AKI, solid organ transplant, contraindications or recent exposure to an SGLT2i, acute MI, on vasopressor, and with baseline eGFR <25ml/min/1.73m² or end-stage HF requiring LVAD or inotrope were excluded. HF symptoms were evaluated at baseline and daily for 3 consecutive days using a visual analogue scale (VAS) for dyspnea and Likert scores for dyspnea and edema. We compared evolution of patient reported dyspnea and edema scores in the acute setting in the 3 days from enrollment.

Results

Between 5/2024-9/2025, 30 adults were enrolled and randomized to dapagliflozin 10mg daily or usual care. The median LOS prior to randomization was 3(1-6) days. 18/30 were admitted primarily with ADHF while the rest developed volume overload during admission. At baseline, the median (IQR) VAS for dyspnea in the SGLT2i arm was 40(0-70)mm vs 20(2-40)mm in the usual care arm. The SGLT2i group had an apparently faster daily decrease in VAS (average slope: -7.7 vs -4.3 mm/day) for dyspnea though the difference was not statistically significant, difference 2.8 (95% CI -5.3, 10.9)mm/day. Patients' reported evolution of symptoms for dyspnea and edema during the 3 days of follow up are shown in alluvial plots (Figure). More patients in the SGLT2i arm reported significant improvement in symptoms between days 1-3 despite higher severity of symptoms at baseline.

Conclusion

SGLT2i initiation in AHF-AKI may be associated with quicker improvement in symptoms. This merits confirmation in a larger trial with longer duration of exposure.

Funding

• Private Foundation Support