Dapagliflozin may cut hyperkalemia risk in half for patients with heart failure
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Patients with heart failure and reduced ejection fraction who were randomized to dapagliflozin had half the risk of moderate to severe hyperkalemia vs. placebo, according to results of the DAPA-HF trial presented at ASN Kidney Week.
These findings remained consistent despite whether patients were on a mineralocorticoid receptor antagonist at baseline.
“Mineralocorticoid receptor antagonists [MRAs] and SGLT2 inhibitors each have diuretic activity, which may lower blood pressure and initially reduce glomerular filtration rate,” Søren L. Kristensen, MD, PhD, of the University of Glasgow, said in his virtual presentation. “Hyperkalemia often limits the use of MRAs in patients with heart failure and reduced ejection fraction [HFrEF] and, as a consequence, patients are denied a potentially life-saving therapy.”
Thus, according to Kristensen, it is important to study the effects of these drugs together.
Seeking to investigate the impact of the SGLT2 inhibitor dapagliflozin on the risk of hyperkalemia, along with other cardiovascular and renal outcomes, Kristensen and colleagues randomized patients to either placebo or dapagliflozin (70.1% of patients were treated with an MRA).
Researchers found mild hyperkalemia and moderate to severe hyperkalemia occurred in 11.1% and 1.4% of patients treated with dapagliflozin, respectively, compared with 12.6% and 2.4% of patients on placebo. Investigators discovered a hazard ratio of 0.86 for mild hyperkalemia and 0.50 for moderate to severe hyperkalemia when comparing dapagliflozin with placebo.
“The benefits of dapagliflozin on heart failure, hospitalization, renal outcomes and mortality were consistent, irrespective of MRA use at baseline, suggesting that the benefits of dapagliflozin and MRAs are additive,” Kristensen concluded. “Dapagliflozin attenuates the risk of moderate to severe hyperkalemia in MRA-treated patients with HFrEF and may facilitate use of MRAs in these patients.”
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Kristensen SL, et al. Paper FR-OR19. Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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