Keywords
heart failure
hypertension
diabetes mellitus
dapagliflozin
How to Cite
Abstract
Introduction. The growing prevalence of cardio-renal-metabolic diseases underscores the importance of early diagnosis and the implementation of a comprehensive therapeutic approach.
Aim. To assess the clinical features and therapeutic efficacy of dapagliflozin in patients with cardio-renal-metabolic syndrome.
Materials and methods. The study enrolled 56 patients with chronic kidney disease (CKD). All participants underwent comprehensive clinical assessment, including echocardiography, biochemical blood test, measurement of glycated hemoglobin (HbA1c), N-terminal pro-B-type natriuretic peptide (NT-proBNP), urinary albumin-to-creatinine ratio, and estimated glomerular filtration rate. The patients were stratified into two groups: Group 1 comprised 30 patients with stage III CKD, while Group 2 included 26 patients with stage IV CKD. Dapagliflozin was incorporated into the treatment regimen.
Results. Clinical manifestations of cardio-renal-metabolic syndrome in the examined patients were characterized by the presence of heart failure (HF) with reduced left ventricular ejection fraction (LVEF), elevated NT-proBNP levels, as well as disturbances in carbohydrate metabolism, electrolyte homeostasis, and renal function. The addition of dapagliflozin to the standard therapeutic regimen resulted in an improvement in LVEF, a significant reduction in NT-proBNP levels by 31.7% (p = 0.0028) and 11.4% (p = 0.012) in Groups 1 and 2, respectively, in patients with HF and mildly reduced LVEF. Furthermore, a decrease in HbA1c was observed by 11.4% (p = 0.041) in patients with impaired glucose tolerance and by 14.8% (p = 0.039) in those with diabetic nephropathy. Under the influence of treatment, a significant reduction in the urinary albumin-to-creatinine ratio was noted in Group 1 by 26.7% (p = 0.022) and in Group 2 by 16.5% (p = 0.047), along with an increase in the estimated glomerular filtration rate by 21.7% (p = 0.027) and 11.3% (p = 0.039), respectively, predominantly in patients with HF and mildly reduced LVEF.
Conclusions. The use of dapagliflozin as part of combination therapy improves clinical outcomes in patients with cardio-renal-metabolic syndrome by enhancing myocardial contractility, optimizing electrolyte balance, and reducing albuminuria, while also increasing the estimated glomerular filtration rate, which provides cardio- and nephroprotection.
References
American Diabetes Association Professional Practice Committee for Diabetes. (2026). Summary of Revisions: Standards of Care in Diabetes – 2026. Diabetes Care, 49(1), S6-S12. https://doi.org/10.2337/dc26-SREV
Koval, S. M. (2025). Urazhennia nyrok yak orhana-misheni u khvorykh na arterialnu hipertenziiu ta tsukrovyi diabet 2-ho typu: mozhlyvosti naibilsh rannoho vyiavlennia [Kidney damage as a target organ in patients with arterial hypertension and type 2 diabetes: the possibility of early detection]. Health of Ukraine, 3(100), 21-22.
Kalantar-Zadeh, K., Jafar, T., Nitsch, D., Neuen, B., & Perkovic, V. (2021). Chronic kidney disease. The Lancet, 398(10302), 786-802. https://doi.org/10.1016/s0140-6736(21)00519-5
Marassi, M., Fadini, G. (2023) .The cardio-renal-metabolic connection: a review of the evidence. Cardiovascular diabetology, 22(195), 1-12. https://doi.org/10.1186/s12933-023-01937-x
Vora, J., Cherney, D., Kosiborod, M., Spaak, J., Kanumilli, N., Khunti, K., Lam, C., Bachmann, M., & Fenici, P. (2024). Inter‐relationships between cardiovascular, renal and metabolic diseases: Underlying evidence and implications for integrated interdisciplinary care and management. Diabetes, Obesity and Metabolism, 26(5), 1567-1581. https://doi.org/10.1111/dom.15485
Mishchenko, L. A., Sokolova, L. K. (2025). Kardio-reno-metabolichnyi patsiient: efektyvnyi menedzhment iz pohliadu kardioloha ta endokrynoloha. Health of Ukraine, 3(100), 18-20.
Kadowaki, T., Maegawa, H., Watada, H., Yabe, D., Node, K., Murohara, T., & Wada, J. (2022). Interconnection between cardiovascular, renal, and metabolic disorders: a narrative review with a focus on Japan. Diabetes, Obesity and Metabolism, 24(12), 2283-2296. https://doi.org/10.1111/dom.14829
Evans, M., Lewis, R., Morgan, A., Whyte, M., Hanif, W., Bain, S., Davies, S., Dashora, U., Yousef, Z., Patel, D., & David, S. (2021). A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future. Advances in Therapy, 39(1), 33-43. https://doi.org/10.1007/s12325-021-01927-z
Jhund, P., Solomon, S., Docherty, K., Heerspink, H., Anand, I., Böhm, M., Chopra, V., de Boer, R., Desai, A., Ge, J., Kitakaze, M., Merkely, B., O'Meara, E., Schou, M., Tereshchenko, S., Verma, S., Vinh, P., Inzucchi, S., Køber, L., Kosiborod, M., Martinez, F., Ponikowski, P., Sabatine, M.., Bengtsson, O., Langkilde, A., Sjöstrand, M., & McMurray, J. (2021). Efficacy of Dapagliflozin on Renal Function and Outcomes in Patients with Heart Failure with Reduced Ejection Fraction: Results of DAPA-HF. Circulation, 143(4), 298-309. https://doi.org/10.1161/CIRCULATIONAHA.120.050391
Heerspink, H., Stefánsson, B., Correa-Rotter, R., Chertow, G., Greene, T., Hou, F., Mann, J., McMurray, J., Lindberg, M., Rossing, P., Sjöström, C., Toto, R., Langkilde, A., &Wheeler, D. (2020). Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine, 383(15), 1436-1446. https://doi.org/doi:10.1056/NEJMoa2024816
Klinichna nastanova 00226 Likuvannia khronichnoi khvoroby nyrok [Clinical guideline 00226 Treatment of chronic kidney disease]. (2017). Kidneys, 9(2), 6-10.
Rekomendatsii Vseukrainskoi asotsiatsii kardiolohiv Ukrainy z diahnostyky, likuvannia ta profilaktyky khronichnoi sertsevoi nedostatnosti [Recommendations of the All-Ukrainian Association of Cardiologists of Ukraine on the diagnosis, treatment and prevention of chronic heart failure]. (2024). Kyiv, 72.
McDonagh T. et al. (2023). Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 44(37), 3627-3639. https://doi.org/10.1093/eurheartj/ehad195
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