Heart Failure Fact or Fiction: Creatinine's Cautionary Tale

A 68-year-old woman with heart failure with reduced ejection fraction (HFrEF; left ventricular ejection fraction 35%), hypertension, hyperlipidemia, and stable chronic kidney disease (CKD) is seen in the clinic 2 weeks after admission for acute decompensated heart failure (HF), for which she required several days of intravenous diuresis. She was discharged on her previous medications: metoprolol succinate 100 mg BID, sacubitril/valsartan 49/51 mg BID, spironolactone 12.5 mg daily, and furosemide 40 mg daily. During her hospitalization, dapagliflozin 10 mg daily was added to her regimen. Prior to discharge, her electrolyte levels were within reference ranges, creatinine (Cr) level was 1.47 mg/dL (glomerular filtration rate [GFR] 49 mL/min/1.73 m2), and N-terminal pro–B-type natriuretic peptide (NT-proBNP) level was 1,253 g/dL.

She states that she is feeling well today, is taking all her medications, and has no other reports. Her heart rate is 72 bpm and blood pressure is 118/75 mm Hg.

On examination, she appears euvolemic, with no jugular venous distention. Her repeat laboratory studies show Cr level 2.03 mg/dL, GFR 44 mL/min/1.73 m2, potassium level 4.5 mmol/L, and NT-proBNP level 937 g/dL.

The clinician decides it would be best to discontinue the sodium-glucose cotransporter-2 inhibitor (SGLT2i) due to Cr level rise.

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