Cardiorenal interactions in heart failure: insights from recent therapeutic advances.

7 , 8 As mentioned, SGLT2i cause an initial decline in (e)GFR, which can be seen immediately after initiation and is generally modest in magnitude (usually <5 mL/min/1.73 m 2 ), but depending on initial eGFR may be significant.

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In FIGHT, where 300 patients with advanced HFrEF after admission for acute HF were randomized to liraglutide or placebo, GLP-1-RA was not associated with better disease stability and showed a trend towards more cardiac events, including re-hospitalization for HF. 53 The number of fatal events was higher with GLP-1-RA as compared with placebo (12 vs. 11%), although not statistically significant.

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In one study, HARMONY, albiglutide was even associated with a reduction of HF admissions (RRR 29%), but other individual studies showed only marginally lower events rates that did not reach statistical significance. 48 In meta-analysis, taking together six large randomized controlled trials (RCTs), GLP-1-RA treatment was associated with a 9% RRR compared with placebo. 46 The ARR over a median follow-up of over 3 years was however only 1%, with an event rate of 4% in the placebo group ( Figure 1 A and B ).

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