Empagliflozin Administration Can Decrease the Dose of Loop Diuretics and Prevent the Exacerbation of Renal Tubular Injury in Patients With Compensated Heart Failure Complicated by Diabetes

Background: Whether the dose of loop diuretics can be decreased by administration of a sodium-glucose cotransporter 2 (SGLT2) inhibitor in diabetic outpatients with compensated heart failure (HF) is unclear. Methods and Results: This study prospectively enrolled 60 diabetic outpatients with compensated HF. Patients were randomly divided into 2 groups: those administered the SGLT2 inhibitor empagliflozin (n=28) and those not (n=30). Changes in the daily dose of loop diuretics, blood sampling data, and urinary renal tubular biomarkers were evaluated 6 months after the intervention. The median (interquartile range) furosemide dose decreased significantly over the 6-month follow-up period in the empagliflozin group (from 40 [20–40] to 20 [10–20] mg), but not in the non-empagliflozin group (from 23 [20–40] to 40 [20–40] mg). Hemoglobin levels increased significantly in the empagliflozin group (from 13.2 [11.9–14.6] to 14.0 [12.7–15.0] g/dL). In addition, excretion of acetyl-β-D-glucosaminidase decreased significantly over the 6-month follow-up in the empagliflozin group (from 4.8 [2.6–11.7] to 3.3 [2.1–5.4] IU/L), especially in the group in which the dose of loop diuretics decreased (from 4.7 [2.5–14.8] to 3.3 [2.1–4.5] IU/L). Conclusions: Empagliflozin administration decreased the dose of loop diuretics and increased the production of erythropoietin, which may help prevent renal tubular injury in diabetic outpatients with HF.