SGLT2 Inhibitors and Treatment of Heart Failure in Severe Renal Insufficiency

Inclusion Criteria: Age 20-75 years Patients with clinically confirmed chronic heart failure who have received treatment for heart failure according to the guidelines in the past two months, New York Heart Association (NYHA) grade II-IV Left ventricular ejection fraction (LVEF) ≤ 40% in the past 1 year Clinically confirmed chronic renal insufficiency, eGFR<20ml/min/1.73m2 or maintenance hemodialysis Exclusion Criteria: Allergy to SGLT-2i ALT or AST >3 times the upper limit of normal value; Or total bilirubin>2 times the upper limit of normal value Urinary or reproductive system infection in the last month Blood potassium is greater than or equal to the upper limit of normal value Patients with acute heart failure Patients who need intravenous diuretics before randomization, and the dose is greater than 40mg furosemide, or other equivalent intravenous loop diuretics Patients who need intravenous vasodilators, including nitrates, before randomization Systolic blood pressure<100mmHg measured during screening or at randomization Hemoglobin<90g/L Uncontrolled serious arrhythmia Myocardial infarction, unstable angina pectoris, hemorrhagic stroke or ischemic stroke in 90 days before randomization Proliferative retinopathy or macular disease, painful diabetes neuropathy, diabetes foot, diabetes ketoacidosis, hyperglycemic hyperosmolality that needed treatment in 90 days before randomization Patients with malignant tumors Drug or alcohol addicts Patients who have donated or transfused blood within 90 days before randomization, or are expected to donate or transfuse blood during the study period Pregnant or lactating women, or patients who cannot take reliable contraceptive measures during the study period Patients with uncontrolled abnormal thyroid function Type 1 diabetes Not suitable evaluated by the investigator