Impact of dapagliflozin, spironolactone, and their combination on markers of kidney function and injury: an analysis from SOGALDI-PEF
Year: 2026
Type: article
Abstract: Disease-modifying treatments for heart failure with mildly reduced or preserved ejection fraction (HFmr/pEF), such as sodium-glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRAs), induce a transient early decline in estimated glomerular filtration rate (eGFR) that has been called the eGFR ‘dip’.1,2 Such eGFR ‘dip’ usually lasts for 2 to 3 months after therapy initiation with a slow recovery thereafter. This treatment-associated eGFR decline is thought to be induced by systemic and intraglomerular hemodynamic changes without ‘true’ kidney injury. As SGLT2i and MRAs, in particular, reduce blood pressure (BP) they may influence kidney hemodynamics, especially in elderly HFpEF populations whose kidney pressure-mediated autoregulation may be impaired.3 In SOGALDI-PEF (Dapagliflozin With or Without Spironolactone for HFpEF; NCT05676684), the dapagliflozin/spironolactone combination reduced BP and eGFR more than dapagliflozin or spironolactone alone at 12 weeks.4 As eGFR decline may have clinical importance and lead to therapeutic changes (e.g. treatment withdrawal), it is important to study whether such treatment-induced eGFR decline reflects kidney injury or simply hemodynamic or transient changes in creatinine filtration and reabsorption without major clinical significance i.e. requiring no therapeutic action other than eGFR monitoring.
DOI: 10.1093/ejhf/xuag117
Authors: João Pedro Ferreira, Joana Mascarenhas, Pedro Marques, Luís Mendonça, Abhinav Sharma, Faiez Zannad, Jorge S Almeida, Ricardo Fontes-Carvalho, Joana Pimenta, Adelino Leite-Moreira, Francisco Vasques-Nóvoa, SOGALDI-PEF investigators, Ana Beatriz Batista, Arsénio Barbosa, Ana Filipa Ferreira, Ana C Oliveira, Ana Santos, Cátia Costa, Cândida Goncalves, Catarina Pereira, Cláudia Teixeira, Carla Sousa, Diana Meireles, Diogo Santos-Ferreira, Francisca Saraiva, Fernando Friões, Gualter Silva, Inês Pereira-Sousa, João Tiago Guimarães, Marta Leite, Maria Inês Matos, Manuela Torrinha, Pedro Rodrigues, Silvia O Diaz
Institutions: Inserm, Universidade do Porto, Centre Hospitalier Régional et Universitaire de Nancy, French Clinical Research Infrastructure Network, Défaillance Cardiovasculaire Aiguë et Chronique, Université de Lorraine, Unidade Local de Saúde Gaia/Espinho, McGill University Health Centre, Research Institute of the McGill University Health Centre, McGill University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7153582376