Short-term renal and cardiac outcomes of combined ARNI and SGLT2 therapy in AHF patients: a prospective single-arm interventional study

Acute heart failure (AHF) requires immediate intervention, with diuretics central to managing volume overload. We conducted a prospective single-arm study to explore changes in diuretic and renal outcomes following initiation of combined angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 (SGLT2) inhibitors therapy in AHF patients. We enrolled 120 patients with left ventricular ejection fraction ≤40% and signs of fluid overload, initiation of combined ARNI and SGLT2 inhibitor therapy post-hemodynamic stabilization. Urine volume, renal function, and cardiovascular biomarkers were assessed over 9 days. Urine volume and diuretic response increased significantly on day 1, stabilizing above baseline levels. Cardiovascular biomarkers showed improvements, with decreased NT-proBNP and increased LVEF, without affecting eGFR. Increased diuresis and improved cardiac function parameters were observed during combination therapy. These hypothesis-generating findings support the need for randomized controlled trials to evaluate the clinical utility of this combination in AHF management. The short-term nature of the study and lack of a control group are limitations, which preclude definitive causal attribution of the observed effects. This study has been registered with the Chinese Clinical Trial Registry under registration number ChiCTR2600118845. Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR2600118845).