Impact on Loop Diuretic Doses When Combining with Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure
by Marcus Pribyl, PharmD, Jared Verber, PharmD
Objective: The primary objective of this evaluation was to determine loop diuretic doses when establishing patients on sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with heart failure with reduced ejection fraction (HFrEF). A secondary objective was to evaluate the correlation between the risk of developing acute kidney injury (AKI) or dehydration leading to emergency department (ED) visits when combing SGLT2i with loop diuretics compared to loop monotherapy.
Methods: This quality improvement project used retrospective observational design. Through chart review, patients were included if they were being followed by the SSM Health Monroe Clinic cardiology clinic with a diagnosis of HFrEF and were using a loop diuretic. Patients were separated into the combination group, which included those who were using both an SGLT2i and a loop diuretic, or the control group if they were utilizing a loop diuretic as monotherapy. Data was collected upon initiation of SGLT2i, at 3 months, at 6 months, at 1 year, and at the end of the evaluation. The dose of loop diuretic normalized to furosemide equivalents was recorded along with the patients' renal labs.
Results: The patients in the combination group had an ~ 8 mg/day reduction in their average loop diuretic usage compared to an increase of about 6 mg/day in the loop monotherapy group. There was no indication of a difference in rates of acute kidney injury between the two groups.
Conclusions: Providers should monitor for the opportunity to reduce loop diuretic doses when initiating an SGLT2i. There were no major changes in renal function when adding an SGLT2i to loop diuretics in patients with HFrEF.
Keywords: Furosemide, Heart Failure, Sodium Potassium Chloride Symporter Inhibitors, Sodium-Glucose Transporter 2 Inhibitors, Stroke Volume, Dehydration, Quality Improvement, Kidney, Acute Kidney Injury, Left Ventricular Dysfunction, Cardiology
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2023 November/December Table of Contents
Objective: The primary objective of this evaluation was to determine loop diuretic doses when establishing patients on sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with heart failure with reduced ejection fraction (HFrEF). A secondary objective was to evaluate the correlation between the risk of developing acute kidney injury (AKI) or dehydration leading to emergency department (ED) visits when combing SGLT2i with loop diuretics compared to loop monotherapy.
Methods: This quality improvement project used retrospective observational design. Through chart review, patients were included if they were being followed by the SSM Health Monroe Clinic cardiology clinic with a diagnosis of HFrEF and were using a loop diuretic. Patients were separated into the combination group, which included those who were using both an SGLT2i and a loop diuretic, or the control group if they were utilizing a loop diuretic as monotherapy. Data was collected upon initiation of SGLT2i, at 3 months, at 6 months, at 1 year, and at the end of the evaluation. The dose of loop diuretic normalized to furosemide equivalents was recorded along with the patients' renal labs.
Results: The patients in the combination group had an ~ 8 mg/day reduction in their average loop diuretic usage compared to an increase of about 6 mg/day in the loop monotherapy group. There was no indication of a difference in rates of acute kidney injury between the two groups.
Conclusions: Providers should monitor for the opportunity to reduce loop diuretic doses when initiating an SGLT2i. There were no major changes in renal function when adding an SGLT2i to loop diuretics in patients with HFrEF.
Keywords: Furosemide, Heart Failure, Sodium Potassium Chloride Symporter Inhibitors, Sodium-Glucose Transporter 2 Inhibitors, Stroke Volume, Dehydration, Quality Improvement, Kidney, Acute Kidney Injury, Left Ventricular Dysfunction, Cardiology
Download PDF
2023 November/December Table of Contents