Effects of empagliflozin on estimated extracellular volume, estimated plasma volume, and measured glomerular filtration rate in patients with heart failure (Empire HF Renal): a prespecified substudy of a double-blind, randomised, placebo-controlled trial
RCT (n=12) found empagliflozin reduced extracellular volume (-0.12L), estimated volume (-7.3%) and GFR (-7.5mL/min) at 12wks vs placebo (all p<0.00). Authors state fluid volume changes might be an important mechanism underlying the beneficial clinical effects of SGLT2 inhibitors.
Source:
The Lancet Diabetes & Endocrinology
SPS commentary:
A related discussion article comments, that based on the cardiorenal benefits seen in cardiovascular outcome trials and in chronic kidney disease and heart failure outcome trials, further elucidation of the mechanisms driving the multisystem benefits of SGLT2 inhibitors in patients with and without type 2 diabetes are of increasing relevance. Such studies might not be necessary to drive implementation, but they are useful for advancing knowledge that will allow innovation in future therapies and their combinations, and for improving communication regarding the rationale for use of these drugs with clinicians and patients.
It concludes that there is little time to waste, as SGLT2 inhibitors have been thrust into the top tier of drugs for potentially treating millions of patients with cardiac or renal disease worldwide, with drug labels rapidly expanding indications and international guidelines starting to adopt recommendations for the use of SGLT2 inhibitors beyond patients with diabetes.