Empagliflozin in Patients with Acute Heart Failure and Diuretic Resistance: Preliminary Data from the DRIP-AHF-1 Trial
Bibliographic record
Abstract
Background: Diuretic resistance is common in acute heart failure and associated with poor clinical outcomes. Chronic kidney disease (CKD) is a major determinant of diuretic resistance. Association of furosemide with sodium-glucose cotransporter 2 inhibitors can potentially overcome diuretic resistance in acute heart failure patients with CKD. Methods: This is a prospective, single-arm, observational, open-label clinical trial. Patients admitted with acute heart failure with estimated glomerular filtration rate (eGFR) of 15-45mL/min/1.73m2 and diuretic resistance, defined as a urinary output (UO)<300mL in the 2 hours post 1-1.5mg/kg IV furosemide, were recruited. These patients received 25mg of empagliflozin 2 hours post a second IV furosemide bolus of 1-1.5mg/kg, administered at least 5 hours after the initial furosemide bolus. Primary outcome is the 3-hour UO post furosemide+empagliflozin on the first day of the study, compared with furosemide alone. Secondary outcomes include fractional excretion of sodium (FENa) and total urinary sodium excretion. Results: From 32 patients screened, 6 patients met inclusion criteria and consented to participate. Median age was 80 (75-84) years, 67% were male, median ejection fraction was 40 (40-55) % and median baseline eGFR 18 (17-25) mL/min/1.73m2. All patients had a strong response to furosemide after empagliflozin administration (Table) Conclusions: Our preliminary data shows that empagliflozin at a dose of 25mg, when added to high dose IV furosemide in patients with acute heart failure, low eGFR and diuretic resistance, is capable of increasing urinary output and urinary sodium excretion. Funding: Private Foundation Support - Data for the primary and secondary outcomes Patient number UO 3h post FST (mL) UO 3h post Empa+FST (mL) FENa 3h post FST (%) FENa 3h post Empa+FST (%) Na excretion 3h post FST (mmol) Na excretion 3h post Empa+FST (mmol) #1 215 290 4.7 7.6 14.4 22.0 #2 345 650 2.3 8.5 19.7 57.9 #3 290 515 7.2 11.3 27.8 55.6 #4 490 775 8.0 11.4 54.8 88.4 #5 80 310 3.3 6.4 6.0 27.0 #6 340 605 5.0 12.4 30.9 67.8 Empa - Empagliflozin; FENa - Fractional excretion of sodium; FST - Furosemide stress test; Na - Sodium; UO - Urinary output
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".