Comparison of Diuretic Effects between Empagliflozin, a Sodium-Glucose Co-Transporter
2 Inhibitor With Osmotic Diuresis, and Tolvaptan, a Water Diuretic, in Two Type 2
Diabetic Patients Taking Sodium Diuretics.
Empagliflozin, one of sodium-glucose co-transporter 2 inhibitors,
The mechanisms behind these benefits of empagliflozin are presumed to include osmotic
diuresis, being rather close to water diuresis than sodium diuresis.
Two cases are presented here, where distinct changes in urinary water and sodium excretion
were seen immediately after replacing tolvaptan, a water diuretic, with empagliflozin.
Case 1 with heart failure showed a large decrease in urinary sodium excretion with a slight
decrease in urine volume. By contrast, Case 2 with nephrotic syndrome showed a large increase
in urinary sodium excretion with an increase in urine volume.
The differences were probably due to distinct diuretic effects of empagliflozin
and tolvaptan in the presence of sodium diuretics as well as distinct pathological conditions.
The recent EMPA-REG OUTCOME trial has demonstrated that empagliflozin,
one of sodium glucose co-transporter 2 inhibitors, in addition to standard care had beneficial effects
on cardiovascular morbidity and mortality in patients with type 2 diabetes at high risk for cardiovascular events.
Unlike strong osmotic diuretics such as intravenously administered mannitol,4 SGLT2
inhibitors seem to be rather close to that of tolvaptan, a selective oral vasopressin V2 -receptor antagonist,5
to promote water diuresis.
Case 1 (Table 1) was a 93-year-old woman with type 2 diabetes, hypertension
and heart failure. She was hospitalized due to the worsening
of heart failure. She was 141 cm in height and 48 kg in weight.
Diabetes Res Open J. 2016; 2(2): 45-49. doi: 10.17140/DROJ-2-128
