CC Cardiol Croat Cardiologia Croatica Cardiol. Croat. 1848-543X 1848-5448 Croatian Cardiac Society CC 2024 19_11-12_448-9 10.15836/ccar2024.448 Extended Abstract Heart failure The effect of SLGT2 inhibitors on serum electrolyte levels, kidney function and NT-proBNP in patients with heart failure with preserved and reduced ejection fraction https://orcid.org/0000-0003-0341-9598ViđakMarin1* https://orcid.org/0000-0001-6983-1409VitlovPetra1 https://orcid.org/0000-0001-6582-4201ĆatićJasmina1 https://orcid.org/0000-0001-5610-6259JordanAna1 https://orcid.org/0000-0002-7828-4870NovakAndrej2 https://orcid.org/0000-0001-6931-5404Ivanović MihajlovićVanja1 https://orcid.org/0000-0003-3962-2774PavlovMarin1 https://orcid.org/0009-0004-1361-3911PuškadijaMarta1 https://orcid.org/0000-0001-9187-7681PavlovićNikola1 https://orcid.org/0000-0002-4550-4056ZeljkovićIvan1 https://orcid.org/0000-0001-6444-2674ManolaŠime13 https://orcid.org/0000-0002-2637-9691JurinIvana1 Dubrava University Hospital, Zagreb, Croatia University of Zagreb, Faculty of Science, Department of Physics, Zagreb, Croatia University of Zagreb School of Medicine, Zagreb, Croatia ADDRESS FOR CORRESPONDENCE: Marin Viđak, Klinička bolnica Dubrava, Avenija Gojka Šuška 6, HR-10000 Zagreb, Croatia. / Phone: +385-98-9011-876 / E-mail: marin.vidjak@gmail.com 112024 112024 19 11-12 448 449 29092024 31102024 Croatian Cardiac Society 2024 Croatian Cardiac Society KEYWORDS: heart failuresodium-glucose cotransporter 2 inhibitorskidney function

Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have become the cornerstone of heart failure (HF) therapy across the ejection fraction (EF) spectrum, with plethora of metabolic effects (1, 2). Knowledge on effects of SGLT2i on electrolyte levels and kidney function in patients with preserved (HFpEF) and reduced HF (HFrEF) is still limited.

Patients and Methods: This was a registry-based study recruiting patients diagnosed with HF from May 2021 to February 2024 in Dubrava University Hospital, Zagreb, Croatia. We extracted data on age, gender, NTproBNP and electrolytes levels, and estimated glomerular filtration rate (eGFR). Patients with mildly reduced EF were grouped with patients with HFrEF.

Results: We have collected data from 1018 patients diagnosed with HF (median age 70 (95%CI 69-70.76) years, 33% female). HFpEF was diagnosed in 125 (12.3%), while HFrEF was diagnosed in 893 (87.7%) patients. There were 69 women (55.2%) in the HFpEF group and 267 women (29.9%) in the HFrEF group. Patients were younger in the HFrEF group (69 vs 73 years, p=.0004). HFpEF group had higher BMI when compared to HFrEF group (30.44 vs 28.67, p=.0074). Initial NTproBNP was higher in the HFrEF group (1615.5 vs 2667pg/L, p<.001). There were no differences in NTproBNP levels at 6 and 12 months between HFrEF and HFpEF groups (Table 1). There were no differences in eGFR or electrolytes serum levels at admission nor in the follow up (Table 2). NTproBNP levels decreased during the 6 and 12 months follow up, respectively (2264 vs 913.5pg/L, p<.0001 and 865 vs 681pg/L, p<.0001), while haematocrit levels increased (0.409 vs 0.424, p<.0001 and 0.4295 vs 0.431, p=.0001). The eGFR remained stable throughout the follow up period (66.45 vs 65.5mL/min/1.73m2, p=.0996 and 66 vs 65.5mL/min/1.73m2, p=.1453).

Participants’ characteristics (N=1018).
HFpEF group (N=125) HFrEF group (N=893) P-value*
Age 73 (72.0-74.94) 69 (68-70) 0.0004
Sex
Male 56 (52.5%) 626 (70.01%)
Female 69 (47.5%) 267 (29.9%)#
Body mass index (kg/m2) 30.44 (28.92-31-37) 28.67 (27.96-29.16) 0.0074
NT-proBNP at admission (pg/L) 1615.5 (1098.43-2020-84) 2667 (2413.96-3083.03) <0.0001
NT-proBNP at 6 months (pg/L) 712 (610.27-1085.1) 938 (862.73-1001.57) 0.0981
NT-proBNP at 12 months(pg/L) 590 (420.94-939.67) 689 (639.71-757.59) 0.6358
eGFR at admission (45mL/min/1.73m2) 65.09 (60.31-69.7) 66 (63.89-67.85) 0.4071
eGFR at 6 months (45mL/min/1.73m2) 66.2 (49.96-73.85) 65.4 (63-67.42) 0.1707
eGFR at 12 months (45mL/min/1.73m2) 63.1 (48.22-77.01) 65.7 (61.23-68.8) 0.2103
Potassium at admission (mmol/L) 4.3 (4.2-4.4) 4.3 (4.3-4.4) 0.8729
Potassium at 6 months (mmol/L) 4.3 (3.96-4.73) 4.3 (4.3-4.4) 0.6646
Potassium at 12 months (mmol/L) 4.5 (4.2-4.61) 4.4 (4.4-4.6) 0.4323
Chloride at admission (mmol/L) 103 (102-103) 103 (102-103) 0.8178
Chloride at 6 months (mmol/L) 102 (101-103) 103 (102-103) 0.400
Chloride at 12 months (mmol/L) 104 (103-104) 103 (103-103) 0.4078
Hematocrit at admission 0.3975 (0.3907-0.4056) 0.411 (0.407-0.415) 0.1042
Hematocrit at 6 months 0.4050 (0.3905-0.4239) 0.426 (0.421-0.0431) 0.0171
Hematocrit at 12 months 0.4265 (0.4010-0.4430) 0.4310 (0.4260-0.4377) 0.3972
* Mann-Whitney test, # Chi square test, p<0.0001HFrEF = heart failure with reduced ejection fraction, HFpEF = heart failure with preserved ejection fraction, NT-proBNP = N-terminal prohormone of brain natriuretic peptide, eGFR = estimated glomerular filtration rate
Comparison of NT-proBNP, hematocrit, kidney function and serum electrolyte levels in patients with heart failure with preserved and reduced ejection fraction.
HFpEF group
C (95% Confidence interval) P-value*
NT-proBNP at admission vs 6 months (pg/L) 1439.5 (989.023-2055.28) vs 741 (615.6-1100-58) 0.0001
NT-proBNP at 6 months vs 12 months (pg/L) 867 (603.32-1214.35) vs 599 (431.62-961.9) 0.4595
eGFR at admission vs 6 months ((45mL/min/1.73m2) 67.06 (56.6-74.32) vs 66.2 (49.96-73.85) 0.0375
eGFR at 6 months vs 12 months (45mL/min/1.73m2) 62.8 (44.83-75) vs 59.2 (57.8-77.01) 0.4595
Hct at admission vs 6 months 0.3925 (0.3832-0.4066) vs 0.4045 (0.3901-4230) 0.2007
Hct at 6 months vs 12 months 0.419 (0.383-0.4354) vs 0.4265 (0.4010-0.4467) 0.0431
Potassium level at admission vs 6 months (mmol/L) 4.15 (4.0-4.372) vs 4.3 (3.964-4.7361) 0.2293
Potassium level at 6 months vs 12 months (mmol/L) 4.1 (3.95-4.45) vs 4.15 (3.95-4.6) 0.375
Chloride level at admission vs 6 months (mmol/L) 103 (100-104) vs 102 (101-103) 0.4320
Chloride level at 6 months vs 12 months (mmol/L) 103 (101.02-104.97) vs 103 (102-104) 0.1055
HFrEF group
C (95% Confidence interval) P-value*
NT-proBNP at admission vs 6 months (pg/L) 2416 (2032.58-2687.03) vs 938 (863.33-1001-42) 0.0001
NT-proBNP at 6 months vs 12 months (pg/L) 865 (765.9-966) vs 685 (637.53-755.56) <0.0001
eGFR at admission vs 6 months ((45mL/min/1.73m2) 66.34 (64.59-68.66) vs 65.4 (63-67.42) 0.3025
eGFR at 6 months vs 12 months (45mL/min/1.73m2) 66.1 (64.23-69.1) vs 65.6 (61.16-68.8) 0.095
Hct at admission vs 6 months 0.4110 (0.4070-0.4160) vs 4.260 (0.4210-0.4310) <0.0001
Hct at 6 months vs 12 months 0.430 (0.422-0.433) vs 0.4310 (0.4259-0.4371) 0.0005
Potassium level at admission vs 6 months (mmol/L) 4.3 (4.2-4.3) vs 4.3 (4.3-4.4) 0.0197
Potassium level at 6 months vs 12 months (mmol/L) 4.3 (4.23-4.4) vs 4.4 (4.227-4.5) 0.5033
Chloride level at admission vs 6 months (mmol/L) 102 (99-104) vs 103 (100-104) 0.0052
Chloride level at 6 months vs 12 months (mmol/L) 103 (101-105) vs 103 (101-105) 0.8231
* Wilcoxon paired sample testHFrEF = heart failure with reduced ejection fraction, HFpEF = heart failure with preserved ejection fraction, NT-proBNP = N-terminal prohormone of brain natriuretic peptide, eGFR = estimated glomerular filtration rate, Hct = hematocrit

Conclusions: There were no differences in electrolyte levels and kidney function between HFpEF and HFrEF groups, confirming that SLGT2 inhibitors provide similar efficacy across the spectrum of HF patients.

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