Introduction:
Type 2 cardiorenal syndrome (CRS-2) is the result of gradual loss of kidney function in patients with chronic heart failure (CHF). Amongst the multiple therapies, dapagliflozin (DAPA) has proven efficacy in both CHF and chronic kidney disease (CKD) patients. The objective of our study was to assess the impact of DAPA on diuretic requirements and kidney function in patients with CRS-2.
Methods:
We searched the electronic database of our tertiary care nephrology facility to include the diagnosed CRS-2 patients. Data on demographics, CHF medications, number of diuretics, and kidney function was collected at baseline and at latest follow-up. Kidney function was assessed by estimated glomerular filtration rate (eGFR) using CKD-EPI formula. Number of acute kidney injury (AKI) episodes before and after adding DAPA were noted. The study protocol was approved by the institutional ethical review board.
Results:
Between January 2018 and March 2024, a total of 33 patients were diagnosed as CRS-2 and 8 were lost to follow-up. Among the 25 cases, the mean age was 67.8±7.0 years and 16% were below 60 years. Male: female ratio was 4:1 and the mean body mass index was 27.0±5.5 kg/m2. Among CHF therapies, 80% were on valsartan-sacubitril. At baseline before the start of DAPA, 60%, 28% and 12% were receiving one, two and three diuretics, respectively. At a median follow-up of 313 days, the number of diuretics either remained equal (52%), reduced (44%) or increased (4%) in count. There was non-significant reduction (p=0.139) in the median (interquartile range25-75) dose of torsemide (Baseline: 92% users) from 20 mg/d (10 to 60 mg/d) to 10 mg/d (8.8 to 32.5 mg/d). Serum eGFR increased in 56% with a median percent change from baseline of 20.6% (7.7% to 39.8%). Proportion of patients who had one or more AKI episodes reduced from 72% before DAPA to 12% at latest follow-up indicating significant reduction in such episodes (p<0.001).
Conclusions:
In patients of CRS-2, addition of DAPA to existing treatment helps to lower the usage of diuretics with short-term positive impact on kidney function. The use of DAPA also helps to reduce AKI episodes in such patients contributing to kidney function preservation. Long term assessment will be helpful to understand the cardiovascular and kidney outcomes in CRS-2.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.