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When treating patients with heart failure, we often must balance the intensity of diuretic therapy with effects on kidney function. Prior studies in the chronic care of heart failure have shown that sodium–glucose cotransporter-2 (SGLT-2) inhibitors induce glucosuria and sodium excretion with nephroprotective effects, raising the possibility that they may be used for diuresis in patients with acute decompensated heart failure.
In a double-blind, placebo-controlled trial, German investigators randomized 60 patients hospitalized for acute decompensated heart failure to receive empagliflozin 25 mg daily or placebo in addition to standard treatments, including loop diuretics. They evaluated cumulative urine output over 5 days. The mean patient a…