Safety and Short-Term Cardiorenal Effects of Initiating SGLT2 Inhibitors During Ramadan Fasting in Non-Diabetic Patients With Heart Failure With Reduced Ejection Fraction
Abstract
Objectives: To evaluate the safety profile and short-term renal, electrolyte, and echocardiographic changes associated with initiating SGLT2 inhibitor therapy during Ramadan fasting in clinically stable, non-diabetic patients with HFrEF.
Methodology: This prospective, non-randomized comparative study enrolled 140 clinically stable non-diabetic HFrEF patients who fasted during Ramadan 2024–2025. Participants were allocated to either initiation of an SGLT2 inhibitor (dapagliflozin 10 mg or empagliflozin 10 mg once daily) in addition to guideline-directed medical therapy (SGLT2 group, n=70) or guideline-directed therapy alone (control group, n=70). Structured weekly clinical follow-up was conducted throughout Ramadan. Renal function and electrolytes were assessed at baseline and post-Ramadan. Echocardiography was performed before and after fasting.
Results: Baseline characteristics were comparable between groups. Urinary tract infections were more frequent in the SGLT2 group (41.4% vs 10%, P0.05). Within the SGLT2 group, creatinine and urea increased modestly but significantly (P<0.001). Both groups demonstrated small but statistically significant reductions in sodium and potassium and modest improvement in LVEF after Ramadan (P<0.001). No cases of ketoacidosis, hospitalization, or fasting discontinuation occurred.
Conclusion: Initiation of SGLT2 inhibitor therapy during Ramadan in clinically stable non-diabetic HFrEF patients was not associated with major short-term safety…
Read the paper
Related studies
- Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
- Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced inflammation and insulin resistance
- SGLT2 Inhibitors in Heart Failure: Targeted Metabolomics and Energetic Metabolism
- Mechanisms of blood pressure reduction with sodium-glucose co-transporter 2 (SGLT2) inhibitors
- Sodium-glucose cotransporter inhibitors: beyond glycaemic control
- Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.