Ertugliflozin in Chronic Heart Failure

Inclusion Criteria:

1. A clinical diagnosis of chronic heart failure (either systolic or diastolic)
2. Chronic daily oral loop diuretic dose use
3. eGFR ≥20 mL/min/1.73 m2
4. English speaking participants only
5. Signed informed consent

Exclusion Criteria:

1. Current use or plan to initiate renal replacement therapy or ultrafiltration
2. Significant bladder dysfunction or urinary incontinence
3. Inability to comply with the serial urine collection procedures
4. Current use of a thiazide or thiazide like diuretics or use within 5 half-lives of the drug, including metolazone
5. Current use of a SGLT-2 inhibitor, or in the treating provider's judgement, contraindication to be withdrawn from current use of an SGLT-2 inhibitor
6. Prior heart transplant, critical stenotic valvular disease or complex congenital heart
7. History of type 1 diabetes, diabetic ketoacidosis, "brittle" diabetes or frequent hypoglycemia or severe hypoglycemic episodes requiring emergent intervention (ER visit or EMS response, glucagon administration or forced oral carbs) in the last 3 months
8. History of or current urosepsis or frequent urinary tract infections
9. Anemia with hemoglobin \<8g/dL (due to required phlebotomy for the study)
10. Pregnancy or breastfeeding
11. Appears unlikely or unable to participate in the required study procedures, as assessed by the study PI, study coordinator, or designee (ex: clinically-significant psychiatric, addictive, or neurological disease)
12. Inability to give written informed consent or follow study protocol
13. Severe peripheral artery disease, previous amputation, or threatened amputation
14. Life expectancy \< 3 months