age ≥18 years

fluency in english

heart failure requiring loop diuretic therapy

loop diuretic dose ≥ 80mg/day furosemide equivalents

stable volume status and diuretic requirement as assessed by treating physician

unstable heart failure

renal replacement therapy or an estimated gfr < 30 ml/min/1.73m2

significant bladder dysfunction

history of hepatic failure

pregnancy

history of hyperinsulinemia/hyperlysinuria