Impact of Dapagliflozin on Diuretic Needs in Children and Adolescents with Heart Failure

Introduction: Dapagliflozin is recommended in the treatment of adult heart failure (HF) based on evidence from large clinical trials. Newland and colleagues demonstrated improvement in BNP and LVEF after initiating dapagliflozin in pediatric HF patients, but further benefit remains unknown. Given the suspected natriuretic effects, the primary objective of this study was to determine the impact of dapagliflozin on diuretic needs in pediatric patients with HF, with secondary assessment of adverse events. Methods: This retrospective, single-center cohort study included patients ≤ 21 years of age who were initiated on dapagliflozin for the treatment of HF from January 1, 2022, to June 30, 2024. Loop diuretic doses were converted to oral furosemide equivalents (OFE) and compared at baseline, 30- and 90-days, and a median final follow-up of 10.8 months post-dapagliflozin initiation. Results: Median baseline diuretic requirement was 0.85 mg/kg/day OFE [IQR: 0.38–4.3 mg/kg/day OFE]. At 30-days, the median dose decreased significantly to 0.45 mg/kg/day OFE [IQR: 0.2–2.2 mg/kg/day OFE; p = 0.003]. A significant reduction was observed at 90 days to 0.45 mg/kg/day OFE [IQR: 0.2–2.3 mg/kg/day; p = 0.002]. At final study follow-up of 10.8 months, median diuretic dose decreased to 0.29 mg/kg/day [IQR 0–2 mg/kg/day; p = 0.055]. Adverse events included urinary tract infections in 2 patients (8%), hypovolemia in 7 patients (29%), and one case of euglycemic ketoacidosis (4%), with no hypoglycemia reported. Conclusion: Dapagliflozin significantly lowers diuretic needs in pediatric HF patients at 30- and 90-day post-initiation, and aids in a clinically meaningful decrease in diuretics at final study follow-up.