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Rigshospitalet - a part of Copenhagen University Hospital
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Relationship of Dapagliflozin With Serum Sodium: Findings From the DAPA-HF Trial

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  • Su Ern Yeoh
  • Kieran F Docherty
  • Pardeep S Jhund
  • Mark C Petrie
  • Silvio E Inzucchi
  • Lars Køber
  • Mikhail N Kosiborod
  • Felipe A Martinez
  • Piotr Ponikowski
  • Marc S Sabatine
  • Olof Bengtsson
  • David W Boulton
  • Peter J Greasley
  • Anna Maria Langkilde
  • Mikaela Sjöstrand
  • Scott D Solomon
  • John J V McMurray
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OBJECTIVES: This study aimed to assess the prognostic importance of hyponatremia and the effects of dapagliflozin on serum sodium in the DAPA-HF (Dapagliflozin And Prevention of Adverse outcomes in Heart Failure) trial.

BACKGROUND: Hyponatremia is common and prognostically important in hospitalized patients with heart failure with reduced ejection fraction, but its prevalence and importance in ambulatory patients are uncertain.

METHODS: We calculated the incidence of the primary outcome (cardiovascular death or worsening heart failure) and secondary outcomes according to sodium category (≤135 and >135 mmol/L). Additionally, we assessed: 1) whether baseline serum sodium modified the treatment effect of dapagliflozin; and 2) the effect of dapagliflozin on serum sodium.

RESULTS: Of 4,740 participants with a baseline measurement, 398 (8.4%) had sodium ≤135 mmol/L. Participants with hyponatremia were more likely to have diabetes, be treated with diuretics, and have lower systolic blood pressure, left ventricular ejection fraction, and estimated glomerular filtration rate. Hyponatremia was associated with worse outcomes even after adjustment for predictive variables (adjusted HRs for the primary outcome 1.50 [95% CI: 1.23-1.84] and all-cause death 1.59 [95% CI: 1.26-2.01]). The benefits of dapagliflozin were similar in patients with and without hyponatremia (HR for primary endpoint: 0.83 [95% CI: 0.57-1.19] and 0.73 [95% CI: 0.63-0.84], respectively, P for interaction = 0.54; HR for all-cause death: 0.85 [95% CI: 0.56-1.29] and 0.83 [95% CI: 0.70-0.98], respectively, P for interaction = 0.96). Between baseline and day 14, more patients on dapagliflozin developed hyponatremia (11.3% vs 9.4%; P = 0.04); thereafter, this pattern reversed and at 12 months fewer patients on dapagliflozin had hyponatremia (4.6% vs 6.7%; P = 0.003).

CONCLUSIONS: Baseline serum sodium concentration was prognostically important, but did not modify the benefits of dapagliflozin on morbidity and mortality in heart failure with reduced ejection fraction. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]: NCT03036124).

Original languageEnglish
JournalJACC. Heart failure
Volume10
Issue number5
Pages (from-to)306-318
Number of pages13
ISSN2213-1779
DOIs
Publication statusPublished - May 2022

Bibliographical note

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

    Research areas

  • Benzhydryl Compounds, Glucosides, Heart Failure, Humans, Hyponatremia/complications, Sodium, Stroke Volume, Ventricular Dysfunction, Left/complications, Ventricular Function, Left

ID: 77842894