Sodium-Glucose Cotransporter-2 Inhibitor for Patients With Acute Cardiorenal Syndrome

Inclusion Criteria:

* Provision of signed and dated informed consent form
* Stated willingness to comply with all study procedures and availability for the duration of the study
* Male or female, aged ≥ 18 and ≤ 85 years-old
* Diagnosed with heart failure of either preserved or reduced left ventricular function
* Have signs of heart failure exacerbation
* Ability to take an oral medication
* Willing to adhere to the SGLT2i vs placebo regimen

Exclusion Criteria:

* AKI can be primarily explained by another etiology
* Current use of SGLT2 inhibitor or exposure in the past 72 hours
* Pregnancy or lactation (pregnancy test prior to enrollment in women of child-bearing age)
* Known allergic reactions to components of an SGLT2 inhibitor
* Treatment with another investigational drug for heart failure different from or in addition to usual care within the 72 hours preceding AKI
* Any individual who meets any of the following criteria will be excluded from participation in this study:
* Documented history of ileal conduit (neobladder)
* No means of collecting urine such as patients with documented incontinence without indwelling or external urinary catheter
* Advanced kidney disease at baseline defined as baseline eGFR \< 25 ml/min/1.73m2
* Unexplained hypoglycemia in the past 30 days from enrollment
* History of Fournier's gangrene (pelvic necrotizing fasciitis)
* History of recurrent urinary tract infection (UTI): defined as documented UTI at least 2x in the preceding 6 months or 3 x in the preceding 12 months
* End-stage kidney disease with dialysis requirement
* Oliguria: defined as less than 30 ml urine output per hour for more than two consecutive hours or less than 500 ml over the preceding 24 hours
* Severe acute kidney injury with indications for dialysis
* Current dialysis receipt for acute kidney injury
* Comfort measures only
* Solid organ transplant on immunosuppression