{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T19:33:43Z","timestamp":1792870423608,"version":"4.5.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,7,26]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Effective diuretic regimens using loop diuretics in patients with acute decompensated heart failure are often limited by the development of worsening kidney function. Sodium-glucose cotransporter-2 inhibitors induce glucosuria and sodium excretion with nephroprotective effects in patients with stable heart failure but their role in acute decompensated heart failure is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this single-center, prospective, double-blind, placebo-controlled, randomized study, we randomly assigned patients with acute decompensated heart failure to empagliflozin 25 mg daily or placebo in addition to standard decongestive treatments that included loop diuretics. The primary end point was cumulative urine output over 5 days. Secondary end points included diuretic efficiency, dynamics in markers of kidney function and injury, and NT-proBNP (N-terminal pro-B-type natriuretic peptide).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Sixty patients were randomized within 12 hours of hospitalization for acute decompensated heart failure. Addition of empagliflozin daily to standard medical treatment of acute decompensated heart failure resulted in a 25% increase in cumulative urine output over 5 days (median 10.8 versus 8.7 L mL in placebo, group difference estimation 2.2 L [95% CI, 8.4 to 3.6];\n                      <jats:italic>P<\/jats:italic>\n                      =0.003). Empagliflozin increased diuretic efficiency compared with placebo (14.1 mL urine per milligram furosemide equivalent [95% CI, 0.6\u201327.7];\n                      <jats:italic>P<\/jats:italic>\n                      =0.041) without affecting markers of renal function (estimated glomerular filtration rate, 51\u00b119 versus 54\u00b117 mL\/min per 1.73 m\u00b2;\n                      <jats:italic>P<\/jats:italic>\n                      =0.599) or injury (total urinary protein, 492\u00b1845 versus 503\u00b1847 mg\/g creatinine;\n                      <jats:italic>P<\/jats:italic>\n                      =0.975; and urinary \u03b11-microglobulin, 55.4\u00b138.6 versus 31.3\u00b133.6 mg\/g creatinine;\n                      <jats:italic>P<\/jats:italic>\n                      =0.066) with more pronounced decrease in NT-proBNP in the empagliflozin group compared with placebo (\u22121861 versus \u2212727.2 pg\/mL after 5 days; quotient in slope, 0.89 [95% CI, 0.83\u20130.95];\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). There were no differences in the incidence of safety events between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Early addition of empagliflozin to standard diuretic therapy increases urine output without affecting renal function in patients with acute decompensated heart failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT04049045.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.122.059038","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T14:00:21Z","timestamp":1658757621000},"page":"289-298","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":212,"title":["Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF)"],"prefix":"10.1161","volume":"146","clinical-trial-number":[{"clinical-trial-number":"nct04049045","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9442-7141","authenticated-orcid":true,"given":"P. Christian","family":"Schulze","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Bogoviku","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7488-4000","authenticated-orcid":true,"given":"Julian","family":"Westphal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawel","family":"Aftanski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz","family":"Haertel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sissy","family":"Grund","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"von Haehling","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, Georg-August-University, University Medical Centre G\u00f6ttingen, Germany (S.v.H.)."},{"name":"German Center for Cardiovascular Research (DZHK), partner site G\u00f6ttingen, Germany (S.v.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Schumacher","sequence":"additional","affiliation":[{"name":"Center for Clinical Studies (U.S.), Friedrich-Schiller-University, University Hospital Jena, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1319-6738","authenticated-orcid":true,"given":"Sven","family":"M\u00f6bius-Winkler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care (P.C.S., J.B., J.W., P.A., F.H., S.G., S.M.-W.), Friedrich-Schiller-University, University Hospital Jena, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Division of Nephrology (M.B.), Friedrich-Schiller-University, University Hospital Jena, 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