Initial decline in estimated glomerular filtration rate after empagliflozin in patients with acute heart failure: insights from EMPULSE

This research aims to explore the effects of certain diabetes medications, specifically sodium-glucose cotransporter 2 inhibitors (SGLT2i), on kidney function in patients experiencing heart failure. Heart failure is a serious condition affecting millions of people worldwide, where the heart struggles to pump enough blood. Many patients with heart failure also have diabetes, making understanding the impact of diabetes medications crucial. SGLT2i are medications that help lower blood sugar levels in people with diabetes by preventing the reabsorption of glucose in the kidneys.

Medications like empagliflozin are known to help reduce the risk of death from heart-related issues and lower the chances of hospitalization due to heart failure. However, they can cause a temporary drop in kidney function, which is measured using a test called estimated glomerular filtration rate (eGFR). An initial decline in estimated glomerular filtration rate (eGFR), known as an "eGFR dip," commonly occurs after starting sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with diabetes and heart failure, but can be concerning.

Previous studies primarily focused on patients with chronic (long-term) heart failure. In contrast, our research targets those with acute (sudden) heart failure, where kidney function can change more rapidly and its effects on patient outcomes are less understood. Interestingly, in some cases, worsening kidney function during hospital stays might actually correlate with better recovery, provided that fluid levels are managed well.

We will use various statistical methods, including regression analyses to predict who might experience an eGFR dip and how this dip relates to overall health outcomes. By comparing patients who do and do not experience an eGFR dip, we aim to understand better the risks and benefits of SGLT2i medications for those with acute heart failure.

This research is necessary as it will provide insights that could improve treatment strategies for patients with both heart failure and diabetes, ultimately enhancing patient care and outcomes.