Dapagliflozin Reduces Hyperkalemia Risk in Heart Failure and reduced ejection fraction (HFrEF) in patients treated with mineralocorticoid receptor antagonists (MRAs), according to a recent study presented at the European Society of Cardiology virtual congress.
Hyperkalaemia often limits the use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure and reduced ejection fraction (HFrEF), denying these patients a life-saving therapy. HFrEF is a complex clinical syndrome characterized by structural and/or functional impairment of the left ventricle, resulting in a decrease in heart pump function.
A study was conducted by Kristensen S et. al to determine whether treatment with the sodium-glucose cotransporter 2 (SGLT-2) inhibitor dapagliflozin reduces the risk of hyperkalaemia associated with MRA use in patients with HFrEF.
The researchers examined the risk of developing mild hyperkalaemia (potassium > 5.5 mmol/L) and moderate/severe hyperkalaemia (>6.0 mmol/L) in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) according to background mineralocorticoid receptor antagonist (MRA) use, and randomized treatment assignment, by use of Cox regression analyses.
The results of the study are as follows:
Overall, 3370 (70.1%) patients in Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF) were treated with a mineralocorticoid receptor antagonist (MRA).
Mild hyperkalaemia and moderate/severe hyperkalaemia occurred in 182 (11.1%) and 23 (1.4%) patients treated with dapagliflozin as compared to 204 (12.6%) and 40 (2.4%) of patients given a placebo.
This yielded a hazard ratio (HR) of 0.86 for mild hyperkalaemia and 0.50 for moderate/severe hyperkalaemia, comparing dapagliflozin to placebo.
The researchers concluded that patients with Heart Failure and reduced ejection fraction (HFrEF) and taking a mineralocorticoid receptor antagonist (MRA) who were randomized to dapagliflozin had half the incidence of moderate/severe hyperkalaemia, compared with those randomized to placebo.
Reference
A study titled, "Dapagliflozin reduces the risk of hyperkalaemia in patients with heart failure and reduced ejection fraction": a secondary analysis DAPA-HF by Kristensen S et. al published at European Society of Cardiology virtual congress.
https://esc365.escardio.org/Congress/215836-dapagliflozin-reduces-the-risk-of-hyperkalaemia-in-patients-with-heart-failure-and-reduced-ejection-fraction-a-secondary-analysis-dapa-hf