1
|
Lopes AC, Lourenço O, Morgado S, Gaspar A, Freire I, Eusébio I, Ribeiro J, Silva M, Mendes M, Fonseca O, Duarte R, Morgado M. Acute Kidney Injury and Electrolyte Imbalances Caused by Dapagliflozin Short-Term Use. Pharmaceuticals (Basel) 2024; 17:420. [PMID: 38675382 PMCID: PMC11053518 DOI: 10.3390/ph17040420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i), has shown demonstrated benefits for renal and cardiovascular outcomes in large clinical trials. However, short-term concerns regarding its impact on renal function and electrolyte balance exist. This study aimed to evaluate the short-term effects of dapagliflozin on renal function and electrolyte balance in patients newly prescribed the medication. A retrospective analysis of 246 patients who initiated dapagliflozin therapy was conducted. Serum creatinine, sodium, and potassium levels were measured at baseline (before dapagliflozin) and 5-8 days after initiation (endpoint). A Wilcoxon signed-rank test, Pearson's chi-square test, and Fischer's exact test were used for the data analysis. Glycemia and sodium levels were significantly higher at the baseline compared to the endpoint (p < 0.001). Conversely, creatinine and potassium levels were significantly higher at the endpoint than at the baseline (p < 0.001). The prevalence of hyponatremia and hyperkalemia were increased at the endpoint (17.5% vs. 10.2% and 16.7% vs. 8.9%, respectively). Although not statistically significant, a trend towards increased hyponatremia with the co-administration of furosemide was observed (p = 0.089). No significant association was found between potassium-sparing medications (p > 0.05) and hyperkalemia, except for angiotensin receptor blockers (p = 0.017). The combination of dapagliflozin and furosemide significantly increased the risk of acute kidney injury (AKI) at the endpoint (p = 0.006). Age, gender, and chronic kidney disease status did not significantly influence the occurrence of AKI, hyponatremia, or hyperkalemia (p > 0.05). These findings emphasize the importance of the close monitoring of renal function and electrolyte balance, particularly in the early stages of dapagliflozin therapy, especially in patients receiving diuretics or renin-angiotensin-aldosterone system inhibitors.
Collapse
Affiliation(s)
- António Cabral Lopes
- Pharmaceutical Services of Local Health Unit of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
| | - Olga Lourenço
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Sandra Morgado
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Andreia Gaspar
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Idalina Freire
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Inês Eusébio
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - João Ribeiro
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Mafalda Silva
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Marta Mendes
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Olímpia Fonseca
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Rute Duarte
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Manuel Morgado
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| |
Collapse
|
2
|
Charaya K, Shchekochikhin D, Agadzhanyan A, Vashkevich M, Chashkina M, Kulikov V, Andreev D. Impact of Dapagliflozin Treatment on Serum Sodium Concentrations in Acute Heart Failure. Cardiorenal Med 2023; 13:101-108. [PMID: 36806178 DOI: 10.1159/000529614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The dynamics of serum sodium are important in acute heart failure (AHF), and hyponatremia is associated with a poor prognosis. The effect of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) on serum sodium concentrations in AHF is unknown. METHODS In a single-centre, controlled, randomized study, patients were prescribed dapagliflozin in addition to standard treatment during the first 24 h of hospitalization versus standard treatments. The pre-specified outcome was an absolute change in plasma sodium concentrations between randomization (first 24 h after admission) and discharge. The secondary outcomes were an absolute change in serum sodium concentrations within 48 h of randomization and the persistence of hyponatremia. RESULTS The sample comprised 285 patients (53% males; average age 73.26 ± 13 years); 140 of these were randomized to the dapagliflozin group. The average ejection fraction was 46 ± 14%; 155 patients (54%) had ischaemic heart failure; and 35% had diabetes mellitus. Median N-terminal pro b-type natriuretic peptide was 4,225 [2,120; 9,105] pg/mL. The average estimated glomerular filtration rate was 53.9 ± 17.2 mL/min. Hospital mortality was 6.7%. At randomization, serum sodium concentrations were 139.8 ± 4.32 mmol/L in the dapagliflozin group versus 140.85 ± 4.04 mmol/L in the control group; p = 0.048. 48 h later, there was an increase in serum sodium in the dapagliflozin group (2 [-2; 4] mmol/L), as compared to the control group (-1 [-3.75; 2]); p < 0.001. This was accompanied by equilibration of the sodium levels between the groups (141.08 ± 4.08 mmol/L in the dapagliflozin group vs. 140.05 ± 4.82 mmol/L in the control group; p = 0.096). At the time of discharge, there was no difference in serum sodium concentrations (140.98 ± 4.77 mmol/L vs. 139.86 ± 4.45 mmol/L; p = 0.082). The increase in serum sodium concentrations during the period of observation [randomization; discharge] was small but statistically significant in the dapagliflozin group (1 [-3; 3.75] mmol/L vs. -2 [-4.5; 2] mmol/L; p = 0.015). Of 36 patients (21 in the dapagliflozin group and 15 in the control group) with baseline hyponatraemia, this persisted in 6 (16.6%) in the dapagliflozin group and in 11 (73.3%) in the control group (p = 0.008). CONCLUSION The use of dapagliflozin in AHF is associated with a tendency to the increase in serum sodium concentrations and lesser persistence of hyponatremia. This effect occurred within the first 48 h and persisted until discharge. The impact of dapagliflozin on serum sodium was more pronounced in patients with hyponatremia at randomization.
Collapse
Affiliation(s)
- Kristina Charaya
- Sechenov University, Department of Cardiology, Functional and Ultrasound Diagnostics, Moscow, Russian Federation
| | - Dmitry Shchekochikhin
- Sechenov University, Department of Cardiology, Functional and Ultrasound Diagnostics, Moscow, Russian Federation
| | - Anna Agadzhanyan
- Sechenov University, Department of Cardiology, Functional and Ultrasound Diagnostics, Moscow, Russian Federation
| | - Maria Vashkevich
- Sechenov University, Department of Cardiology, Functional and Ultrasound Diagnostics, Moscow, Russian Federation
| | - Maria Chashkina
- Sechenov University, Department of Cardiology, Functional and Ultrasound Diagnostics, Moscow, Russian Federation
| | - Valeri Kulikov
- Sechenov University, Department of Cardiology, Functional and Ultrasound Diagnostics, Moscow, Russian Federation
| | - Denis Andreev
- Sechenov University, Department of Cardiology, Functional and Ultrasound Diagnostics, Moscow, Russian Federation
| |
Collapse
|
3
|
Lapteva AE, Nasonova SN, Zhirov IV, Tereshchenko SN. SGLT2 inhibitors in acute decompensated heart failure, what do we know? TERAPEVT ARKH 2022; 94:565-571. [DOI: 10.26442/00403660.2022.04.201449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/10/2023]
Abstract
The current worldwide prevalence of heart failure is growing, while its combination with cardiovascular and other conditions determines a poor prognosis in these patients. Furthermore, acute decompensated heart failure is associated with a low survival rate mostly caused by target organ damage. The effects of early administration of SGLT2 inhibitors on renal function in patients with acute decompensated heart failure are being studied to determine the possibility of improving response to treatment, as well as partial or complete recovery of renal function. The goal of the review was to synthesize currently available evidence for the use of SGLT2 inhibitors in patients with acute decompensated heart failure. A systematic search for studies published from 2018 to 2021 and their analysis was carried out in the following databases: Web of Science, Scopus, PubMed/MEDLINE.
Collapse
|