Effect of Empagliflozin on Kidney Biochemical and Imaging Outcomes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure with Reduced Ejection Fraction (SUGAR-DM-HF)

Circulation 2022;146:364-7 DOI: 10.1161/CIRCULATIONAHA.122.059851

Other trials have assessed SGLT2i with kidney MRI, but in patients without heart failure. SUGAR-DM-HF enrolled 105 patients with type 2 diabetes (T2D) or prediabetes, and heart failure with a left ventricular ejection fraction of 40% or less.

Empagliflozin reduced kidney perfusion measured by ASL, with directionally concordant changes in MRR, and reduced aECV in patients with HFrEF and T2D or prediabetes. It is speculated that the reduction in kidney apparent extracellular volume (aECV) represents kidney decongestion by reduction in renal interstitial fluid. Other MRI findings suggest possible protective effects against glomerular hyperfiltration, with reduction in aterial spin labelling (ASL) as a surrogate of intraglomerular perfusion.