Initial Decline (“Dip”) in Estimated Glomerular Filtration Rate Following Initiation of Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: Insights From DAPA-HF

Circulation 2022; Online ahead of print doi: 10.1161/CIRCULATIONAHA.121.058910

The results of this subgroup analysis from DAPA-HF show that – although estimated glomerular filtration rate (eGFR) decline is generally associated with poorer prognosis in most situations – an initial dip with a sodium-glucose co-transporter-2 inhibitor (SGLT2i) may be associated with slower rate of decline in kidney function.

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Effects of Empagliflozin on Symptoms, Physical Limitations and Quality of Life in Patients Hospitalized for Acute Heart Failure – Results From the EMPULSE Trial

Circulation 2022; online ahead of print doi:10.1161/CIRCULATIONAHA.122.059725

This post hoc and prespecified analysis of the EMPULSE trial found that initiation of empagliflozin in patients hospitalised for acute heart failure (AHF) produced clinical benefit regardless of the degree of symptomatic impairment at baseline. Empagliflozin also improved symptoms, physical limitations, and quality of life – with benefits seen as early as 15 days and maintained through 90 days.

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Albuminuria-Lowering Effect of Dapagliflozin, Eplerenone, and Their Combination in Patients With Chronic Kidney Disease: A Randomized Cross-Over Clinical Trial

J Am Soc Nephrol 2022; ahead of print doi:10.1681/ASN.2022020207

This trial demonstrates that the albuminuria-lowering effects of dapagliflozin and eplerenone alone are additive when used in combination. A larger trial in this population is required to confirm long-term efficacy and safety of combined sodium-glucose co-transporter-2 inhibitor (SGLT2i) and mineralocorticoid receptor antagonist (MRA) treatment, but this may support the idea that these classes have complementary nephroprotective effects.

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Randomized Controlled Trial of the Hemodynamic Effects of Empagliflozin in Patients With Type 2 Diabetes at High Cardiovascular Risk: The SIMPLE Trial

Diabetes 2022;71:812–20 doi.org/10.2337/db21-0721

In this analysis of data from the SIMPLE trial, empagliflozin did not reduce left heart filling pressure more than placebo at submaximal exercise in patients with T2D at high CV risk. However, it was observed that empagliflozin reduced pulmonary capillary wedge pressure (PCWP) at a magnitude of clinical significance in patients at rest. The findings suggest cardiac benefits beyond the diuretic effect of sodium-glucose co-transporter-2 inhibitor (SGLT2i) treatment and could explain a significant part of the CV benefits observed in clinical trials.

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Empagliflozin and Incidence of Events Consistent With Acute Kidney Injury: Pooled Safety Analysis in >15,000 Individuals

Diabetes Obes Metab 2022;doi:10.1111/dom.14694 Ahead of print

This comprehensive analysis indicates that empagliflozin is not associated with increased risk of acute kidney injury or acute kidney failure compared with placebo treatment.

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Effect of the Glucagon-Like Peptide-1 Receptor Agonists Semaglutide and Liraglutide on Kidney Outcomes in Patients With Type 2 Diabetes: Pooled Analysis of SUSTAIN 6 and LEADER

Circulation 2022;145:575–85 doi: 10.1161/CIRCULATIONAHA.121.055459

In this analysis by Shaman et al., semaglutide and liraglutide offered kidney-protective effects in patients with type 2 diabetes, especially those with pre-existing chronic kidney disease.

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Effects of canagliflozin on Myocardial Infarction: A Post Hoc Analysis of the CANVAS Programme and CREDENCE Trial

Cardiovasc Res 2022;118:1103–14

Yu et al. report that canagliflozin is not associated with a reduction in overall myocardial infarction in the pooled CANVAS and CREDENCE population. The CANVAS cohort found a possible differential effect on ST-elevation myocardial infarction (STEMI) and non-STEMI warranting further investigation.

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The Comparative Cardiovascular and Renal Effectiveness of Sodium-Glucose Co-Transporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists: A Scandinavian Cohort Study

Diabetes Obes Metab 2022;24:473–85 doi: 10.1111/dom.14598

In this study by Ueda et al., SGLT2 inhibitors were associated with a similar risk of heart failure and a lower risk of serious renal events compared with GLP-1 receptor agonist,s and the use of GLP-1 receptor agonists was associated with a slightly lower risk of MACE compared with SGLT2 inhibitors.

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