Introduction The dynamics of serum sodium are important in acute heart failure (AHF), and hyponatremia is associated with a poor prognosis. The effect of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) on serum sodium concentrations in AHF is unknown. Methods In a single-centre, controlled, randomized study, patients were prescribed dapagliflozin in addition to standard treatment during the first 24 hours of hospitalization, versus standard treatments. The pre-specified outcome was an absolute change in plasma sodium concentrations between randomization (first 24 hours after admission) and discharge. The secondary outcomes were an absolute change in serum sodium concentrations within 48 hours of randomization, and the persistence of hyponatremia. Results The sample comprised 285 patients (53% males; average age 73.26 ± 13 years); 140 of these were randomized to the dapagliflozin group. The average ejection fraction (EF) was 46 ± 14%; 155 patients (54%) had ischaemic heart failure; and 35% had diabetes mellitus. Median N-terminal pro b-type natriuretic peptide (NT-proBNP) was 4225 [2120; 9105] pg/ml. The average estimated glomerular filtration rate (eGFR) was 53.9 ± 17.2 ml/min. Hospital mortality was 6.7%. At randomization, serum sodium concentrations were 139.8 ± 4.32 mmol/l in the dapagliflozin group vs. 140.85 ± 4.04 mmol/l in the control group; р = 0.048. 48 hours later, there was an increase in serum sodium in the dapagliflozin group (2 [-2; 4] mmol/l), as compared to the control group (-1 [-3.75; 2]); р

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