{"id":"0e7fc49bdef7","type":"article","url":"https://hartvaat.nl/2020/11/03/sglt2-remming-plus-lisdiuretica-bij-diabetes-type-2-met-ckd-renale-en-cv-effecte/","title":"SGLT2-remming plus lisdiuretica bij diabetes type 2 met CKD: renale en CV-effecten","title_en":"Renal and Cardiovascular Effects of SGLT2 Inhibition in Combination With Loop Diuretics in Patients With Type 2 Diabetes and Chronic Heart Failure: The RECEDE-CHF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["canagliflozine","cardiorenal-behandelstrategie","chronische-nierziekte","dapagliflozine","fidelio-dkd","figaro-dkd","flow-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.048739","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.048739","authors":["Natalie A Mordi","Ify R Mordi","Jagdeep S Singh","Rory J McCrimmon","Allan D Struthers","Chim C Lang"],"significance":6,"published":"2020-11-03","source_date":"2020-11-03","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This study characterized the renal and cardiovascular effects of combining SGLT2 inhibitors with loop diuretics in diabetic patients with CKD, showing additive natriuretic and hemodynamic benefits without excessive volume depletion.","created":"2026-07-03T10:28:52Z","updated":"2026-07-03T13:28:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de renale en cardiovasculaire effecten van SGLT2-remming in combinatie met lisdiuretica bij diabetes met CKD.","abstract_original":"BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors improve heart failure-associated outcomes in patients with type 2 diabetes. In patients with heart failure, SGLT2 inhibitors will likely be coprescribed with a loop diuretic, but this combined effect is not well-defined. Our aim was to assess the diuretic and natriuretic effect of empagliflozin in combination with loop diuretics. METHODS: The RECEDE-CHF trial (SGLT2 Inhibition in Combination With Diuretics in Heart Failure) was a randomized, double-blind, placebo-controlled, crossover trial of patients with type 2 diabetes and heart failure with reduced ejection fraction taking regular loop diuretic who were randomized to empagliflozin 25 mg once daily or placebo for 6 weeks with a 2-week washout period. The primary outcome was change in 24-hour urinary volume from baseline to week 6. RESULTS: Twenty-three participants (mean age, 69.8 years; 73.9% male; mean furosemide dose, 49.6±31.3 mg/d; mean HbA1c, 7.9±3.8%) were recruited. Compared with placebo, empagliflozin caused a significant increase in 24-hour urinary volume at both day 3 (mean difference, 535 mL [95% CI, 133-936]; P=0.005) and week 6 (mean difference, 545 mL [95% CI, 136-954]; P=0.005) after adjustment for treatment order, baseline 24-hour urine volume, and percentage change in loop diuretic dose. At 6 weeks, empagliflozin did not cause a significant change in 24-hour urinary sodium (mean difference, -7.85 mmol/L [95% CI, -2.43 to 6.73]; P=0.57). Empagliflozin caused a nonsignificant increase in fractional excretion of sodium at day 3, which was absent at week 6 (mean difference day 3, 0.30% [95% CI, -0.03 to 0.63]; P=0.09; week 6, 0.11% [95% CI, -0.22 to 0.44]; P>0.99), and a significant increase in electrolyte-free water clearance at week 6 (mean difference, 312 mL [95% CI, 26-598]; P=0.026) compared with placebo. Empagliflozin also caused significant reductions in body weight and serum urate at week 6. CONCLUSIONS: Empagliflozin caused a significant increase in 24-hour urine volume without an increase in urinary sodium when used in combination with loop diuretic. Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03226457."}