Randomized Trial of Sodium-glucose Cotransporter 2 Inhibition in Heart Transplant Recipients
VA Office of Research and Development
Summary
Heart transplant (HTx) is an established therapy for advanced heart disease that restores quality of life and improves survival. However, due to preexisting comorbidities combined with the immunosuppressive therapies required after transplantation, HTx recipients remain at high risk for kidney, cardiovascular (CV), and metabolic disease. Large randomized clinical trials have recently shown that sodium-glucose cotransporter 2 inhibitors (SGLT2i) have potent kidney protective and CV benefits in many populations of patients with chronic kidney disease (CKD), CV disease and/or diabetes. SGLT2i have not been studied prospectively in HTx recipients, which represents a barrier to their use in this population. In this multicenter randomized controlled trial in Veterans with HTx, investigators will evaluate the potential benefits of empagliflozin on kidney function, cardiometabolic risk, erythropoiesis, and functional status. A total of 200 Veterans will be randomly assigned to receive either empagliflozin 10 mg daily or a matching placebo for 12 months.
Description
Heart transplant (HTx) markedly improves patient health-related quality of life (hrQoL) and survival in advanced heart failure (HF). However, HTx recipients remain at elevated risk for kidney and cardiovascular (CV) morbidity and mortality. Mitigating the negative effects of these morbidities on long-term survival and on patient hrQoL after HTx is a critical unmet need. Large clinical trials have recently shown that sodium glucose cotransporter 2 inhibitors (SGLT2i) have potent kidney protective and CV benefits. By preventing glucose reabsorption in the renal proximal tubule and promoting glyc…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Age 18 years or older 2. Heart transplant recipient, 3 months after transplant Exclusion Criteria: 1. eGFR \<20 mL/min/1.73m2 2. Type 1 diabetes mellitus 3. HbA1C \>10% 4. Baseline UACR \<30 mg/g in patients without T2D 5. Known allergy or intolerance to SGLT2i 6. Active uncontrolled infection 7. Multiorgan transplant 8. SGLT2i treatment in the last 30 days 9. Pregnancy, breast-feeding or woman of child-bearing age not on birth control
Interventions
- DrugEmpagliflozin
A starting dose of empagliflozin 10 mg or matching placebo will be initiated after randomization and completion of the baseline testing. Participating subjects will remain at this dose for the whole study duration of 12 months.
- DrugPlacebo
A starting dose of empagliflozin 10 mg or matching placebo will be initiated after randomization and completion of the baseline testing. Participating subjects will remain at this dose for the whole study duration of 12 months.
Locations (6)
- VA Palo Alto Health Care System, Palo Alto, CAPalo Alto, California
- Tennessee Valley Healthcare System Nashville Campus, Nashville, TNNashville, Tennessee
- Michael E. DeBakey VA Medical Center, Houston, TXHouston, Texas
- VA Salt Lake City Health Care System, Salt Lake City, UTSalt Lake City, Utah
- Hunter Holmes McGuire VA Medical Center, Richmond, VARichmond, Virginia
- William S. Middleton Memorial Veterans Hospital, Madison, WIMadison, Wisconsin