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RecruitingNCT06307652BalanceD-HFUpdated Sep 11, 2026

Study to Evaluate the Effect of Balcinrenone/Dapagliflozin in Patients With Heart Failure and Impaired Kidney Function

A Phase 3 interventional study of balcinrenone/dapagliflozin 15 mg/10 mg and matching placebo for dapagliflozin 10 mg and balcinrenone/dapagliflozin 40 mg/10 mg and matching placebo for dapagliflozin 10 mg in Heart Failure and Impaired Kidney Function, sponsored by AstraZeneca. Recruiting at 852 sites in 39 countries. Open to participants aged 18 Years to 130 Years. Per ClinicalTrials.gov, last updated 2026-09-11.

Sponsored by AstraZeneca · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
3,850
Allocation
Randomized
Ages
18 Years to 130 Years
Sex
All
01

Study summary

This is a Phase III, international, multi-centre, randomised, double-blind, parallel-group, double-dummy, active-controlled, event-driven study in patients with chronic HF and impaired kidney function who had a recent HF event. The aim is to evaluate the effect of balcinrenone/dapagliflozin vs dapagliflozin, given once daily on top of other classes of SoC, on CV death and HF events.

Read the detailed description

The purpose of this study is to investigate the effect of balcinrenone/dapagliflozin compared with dapagliflozin, on the risk of CV death, HF event with and without hospitalisation, in patients with chronic HF, impaired kidney function, and who have had a recent HF event.

Eligible patients will randomly be assigned with a 1:1:1 ratio to receive once daily administration of one capsule and one tablet of one of the following treatments:

  1. Balcinrenone/dapagliflozin 15 mg/10 mg capsule and matching placebo for dapagliflozin 10 mg tablet
  2. Balcinrenone/dapagliflozin 40 mg/10 mg capsule and matching placebo for dapagliflozin 10 mg tablet
  3. Dapagliflozin 10 mg tablet and matching placebo for balcinrenone/dapagliflozin capsule

The study will be conducted at approximately 700 sites in approximately 40 countries globally.

02

Conditions studied

  • Heart Failure and Impaired Kidney Function

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03

Who can participate

Ages eligible
18 Years to 130 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Age ≥ 18 years
  • Documented diagnosis of symptomatic HF (NYHA functional class II-IV)
  • Having had a recent HF event within 6 months (hospitalization or urgent visit)
  • Have a LVEF value from an assessment within the last 12 months
  • Managed with SoC therapy for HF and renal impairment according to local guidelines
  • NT-proBNP must be >300 pg/mL (>600 pg/mL if concomitant atrial fibrillation or atrial flutter)
  • Not taking an MRA
  • An eGFR ≥ 20 to \< 60 mL/min/1.73 m2
  • Serum/plasma potassium ≤ 5.0 mmol/L

Exclusion criteria

Exclusion Criteria:

  • Acute coronary syndrome (unstable angina or myocardial infarction), stroke or transient ischaemic attack within the previous 3 months prior to enrolment or during the screening period
  • Major cardiac surgery, coronary revascularisation or valvular repair or replacement, or implantation of a Cardiac resynchronisation therapy device within 3 months prior to enrolment or during the screening period, or planned to undergo any of these operations
  • History of hypertrophic obstructive cardiomyopathy
  • Complex congenital heart disease or severe uncorrected primary valvular disease
  • Symptomatic bradycardia or second- or third-degree heart block without a pacemaker
  • Systolic BP \< 90 mmHg, or symptomatic hypotension within the past 24 hours
  • Primary pulmonary hypertension, chronic pulmonary embolism, severe pulmonary disease including COPD or exacerbation of COPD requiring invasive mechanical ventilation assistance within 12 months prior to enrolment
  • Type 1 diabetes mellitus
  • Kidney replacement therapy in the past 4 weeks, currently requiring kidney replacement or imminent plan to start kidney replacement therapy
  • Acute or chronic liver disease with severe impairment of liver function, eg, ascites, oesophageal varices, coagulopathy, and encephalopathy
  • Suspected or confirmed COVID-19 infection within the last 4 weeks or hospitalisation for COVID-19 within the last 12 weeks
  • Treatment with strong or moderate CYP3A4 inhibitor or inducer
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
3,850 participants (estimated)

Study arms

  • Experimental
    balcinrenone/dapagliflozin 15 mg/10 mg

    Patients will be randomized 1:1:1 to either combination of balcinrenone/dapagliflozin and matching placebo for dapagliflozin or dapagliflozin and matching placebo for balcinrenone/dapagliflozin

    Drug: balcinrenone/dapagliflozin 15 mg/10 mg and matching placebo for dapagliflozin 10 mg

  • Experimental
    balcinrenone/dapagliflozin 40 mg/10 mg

    Patients will be randomized 1:1:1 to either combination of balcinrenone/dapagliflozin and matching placebo for dapagliflozin or dapagliflozin and matching placebo for balcinrenone/dapagliflozin

    Drug: balcinrenone/dapagliflozin 40 mg/10 mg and matching placebo for dapagliflozin 10 mg

  • Active comparator
    dapagliflozin 10 mg

    Patients will be randomized 1:1:1 to either combination of balcinrenone/dapagliflozin and matching placebo for dapagliflozin or dapagliflozin and matching placebo for balcinrenone/dapagliflozin

    Drug: dapagliflozin 10 mg and matching placebo for balcinrenone/dapagliflozin

Interventions

  • Drugbalcinrenone/dapagliflozin 15 mg/10 mg and matching placebo for dapagliflozin 10 mg

    1 capsule of balcinrenone/dapagliflozin 15 mg/10 mg and 1 tablet of matching placebo for dapagliflozin 10 mg once daily, oral use

  • Drugbalcinrenone/dapagliflozin 40 mg/10 mg and matching placebo for dapagliflozin 10 mg

    1 capsule of balcinrenone/dapagliflozin 40 mg/10 mg and 1 tablet of matching placebo for dapagliflozin 10 mg once daily, oral use

  • Drugdapagliflozin 10 mg and matching placebo for balcinrenone/dapagliflozin

    1 tablet of dapagliflozin 10 mg and 1 capsule of matching placebo for balcinrenone/dapagliflozin once daily, oral use

05

What researchers measure

Primary outcomes

  1. Time to first occurrence of any of the components of the composite of: •CV death •HF hospitalisation •HF event without hospitalisation

    To determine whether balcinrenone/dapagliflozin is superior to dapagliflozin in reducing the risk of CV death and HF events with and without hospitalisation

    Time frame: Approximately 36 months

Secondary outcomes

  1. Total occurrences (first and recurrent) of the components of the composite of: •CV death •HF hospitalisation •HF event without hospitalisation

    To determine whether balcinrenone/dapagliflozin is superior to dapagliflozin in reducing the rate of total occurrences of CV death, and HF events with and without hospitalisation

    Time frame: Approximately 36 months

  2. Total occurrences (first and recurrent) of HF hospitalisations

    To determine whether balcinrenone/dapagliflozin is superior to dapagliflozin in reducing the rate of total HF hospitalisations

    Time frame: Approximately 36 months

  3. Time to CV death

    To determine whether balcinrenone/dapagliflozin is superior to dapagliflozin in reducing the risk of CV death

    Time frame: Approximately 36 months

  4. Time to death from any cause

    To determine whether balcinrenone/dapagliflozin is superior to dapagliflozin in reducing the risk of death from any cause

    Time frame: Approximately 36 months

  5. The hierarchical composite endpoint of death from any cause, total HF events, and change from baseline in KCCQ total symptom score to 24- week post-randomisation

    To determine whether balcinrenone/dapagliflozin is superior to dapagliflozin in reducing the risk of death from any cause, HF events, and improving patient reported symptoms of HF

    Time frame: Approximately 24 weeks

06

Study locations

631 of 852 sites recruiting
  • Research Site
    Alexander City, Alabama 35010, United States
    Recruiting
  • Research Site
    Birmingham, Alabama 35209, United States
    Withdrawn
  • Research Site
    Fairhope, Alabama 36532, United States
    Recruiting
  • Research Site
    Huntsville, Alabama 35801, United States
    Recruiting
  • Research Site
    Phoenix, Arizona 85016, United States
    Recruiting
  • Research Site
    Phoenix, Arizona 85044, United States
    Recruiting
  • Research Site
    Little Rock, Arkansas 72205, United States
    Recruiting
  • Research Site
    Beverly Hills, California 90211, United States
    Recruiting
  • Research Site
    Covina, California 91723, United States
    Recruiting
  • Research Site
    Encinitas, California 92024, United States
    Terminated
  • Research Site
    Los Angeles, California 90073, United States
    Recruiting
  • Research Site
    Los Angeles, California 90089, United States
    Recruiting
  • Research Site
    Newport Beach, California 92663, United States
    Terminated
  • Research Site
    Orange, California 92868, United States
    Withdrawn
  • Research Site
    Redding, California 96001, United States
    Recruiting
  • Research Site
    San Diego, California 92123, United States
    Recruiting
  • Research Site
    San Francisco, California 94110, United States
    Recruiting
  • Research Site
    San Francisco, California 94121, United States
    Terminated
  • Research Site
    Santa Ana, California 92704, United States
    Withdrawn
  • Research Site
    Thousand Oaks, California 91360, United States
    Terminated
  • Research Site
    Vista, California 92081, United States
    Recruiting
  • Research Site
    West Hills, California 91307, United States
    Recruiting
  • Research Site
    Aurora, Colorado 80045, United States
    Recruiting
  • Research Site
    Wheat Ridge, Colorado 80033, United States
    Terminated
  • Research Site
    Altamonte Springs, Florida 32701, United States
    Terminated
  • Research Site
    Boca Raton, Florida 33486, United States
    Recruiting
  • Research Site
    Bradenton, Florida 34209, United States
    Recruiting
  • Research Site
    Clearwater, Florida 33756, United States
    Withdrawn
  • Research Site
    Delray Beach, Florida 33484, United States
    Recruiting
  • Research Site
    Fort Lauderdale, Florida 33308, United States
    Recruiting
  • Research Site
    Gainesville, Florida 32610, United States
    Recruiting
  • Research Site
    Jacksonville, Florida 32209, United States
    Recruiting
  • Research Site
    Miami, Florida 33133, United States
    Terminated
  • Research Site
    Miami, Florida 33176, United States
    Recruiting
  • Research Site
    Miami Lakes, Florida 33014, United States
    Recruiting
  • Research Site
    Palm Beach Gardens, Florida 33410, United States
    Recruiting
  • Research Site
    Pensacola, Florida 32503, United States
    Recruiting
  • Research Site
    Port Charlotte, Florida 33952, United States
    Withdrawn
  • Research Site
    Safety Harbor, Florida 34695, United States
    Recruiting
  • Research Site
    Saint Augustine, Florida 32086, United States
    Recruiting
  • Research Site
    St. Petersburg, Florida 33701, United States
    Recruiting
  • Research Site
    Tampa, Florida 33617, United States
    Recruiting
  • Research Site
    Atlanta, Georgia 30303, United States
    Recruiting
  • Research Site
    Atlanta, Georgia 30309, United States
    Recruiting
  • Research Site
    Peachtree City, Georgia 30269, United States
    Recruiting
  • Research Site
    Thomasville, Georgia 31792, United States
    Withdrawn
  • Research Site
    Tucker, Georgia 30084, United States
    Recruiting
  • Research Site
    Chicago, Illinois 60612, United States
    Withdrawn
  • Research Site
    Chicago, Illinois 60637, United States
    Recruiting
  • Research Site
    Glenview, Illinois 60026, United States
    Withdrawn
  • Research Site
    Hazel Crest, Illinois 60429, United States
    Recruiting
  • Research Site
    North Chicago, Illinois 60064, United States
    Terminated
  • Research Site
    Peoria, Illinois 61614, United States
    Recruiting
  • Research Site
    Winfield, Illinois 60190, United States
    Recruiting
  • Research Site
    Elkhart, Indiana 46514, United States
    Recruiting
  • Research Site
    Evansville, Indiana 47710, United States
    Recruiting
  • Research Site
    Hammond, Indiana 46324, United States
    Recruiting
  • Research Site
    Indianapolis, Indiana 46237, United States
    Withdrawn
  • Research Site
    Muncie, Indiana 47303, United States
    Recruiting
  • Research Site
    Munster, Indiana 46321, United States
    Recruiting
  • Research Site
    Richmond, Indiana 47374, United States
    Withdrawn
  • Research Site
    Waterloo, Iowa 50701, United States
    Recruiting
  • Research Site
    Wichita, Kansas 67218, United States
    Withdrawn
  • Research Site
    Wichita, Kansas 67226, United States
    Recruiting
  • Research Site
    Louisville, Kentucky 40202, United States
    Terminated
  • Research Site
    Alexandria, Louisiana 71301, United States
    Withdrawn
  • Research Site
    New Orleans, Louisiana 70121, United States
    Withdrawn
  • Research Site
    Shreveport, Louisiana 71105, United States
    Withdrawn
  • Research Site
    West Monroe, Louisiana 71291, United States
    Recruiting
  • Research Site
    Augusta, Maine 04330, United States
    Withdrawn
  • Research Site
    Rockville, Maryland 20850, United States
    Recruiting
  • Research Site
    Boston, Massachusetts 02114, United States
    Recruiting
  • Research Site
    Fall River, Massachusetts 02721, United States
    Withdrawn
  • Research Site
    Worcester, Massachusetts 01655, United States
    Recruiting
  • Research Site
    Ann Arbor, Michigan 48109, United States
    Withdrawn
  • Research Site
    Bloomfield Hills, Michigan 48304, United States
    Recruiting
  • Research Site
    Dearborn, Michigan 48126, United States
    Terminated
  • Research Site
    Farmington Hills, Michigan 48334, United States
    Withdrawn
  • Research Site
    Flint, Michigan 48504, United States
    Suspended
  • Research Site
    Troy, Michigan 48098, United States
    Withdrawn
  • Research Site
    Ypsilanti, Michigan 48197, United States
    Recruiting
  • Research Site
    Minneapolis, Minnesota 55455, United States
    Withdrawn
  • Research Site
    Saint Paul, Minnesota 55109, United States
    Recruiting
  • Research Site
    Jackson, Mississippi 39216, United States
    Recruiting
  • Research Site
    Columbia, Missouri 65201, United States
    Recruiting
  • Research Site
    Kansas City, Missouri 64111, United States
    Recruiting
  • Research Site
    Kansas City, Missouri 64128, United States
    Recruiting
  • Research Site
    Lincoln, Nebraska 68506, United States
    Recruiting
  • Research Site
    Lincoln, Nebraska 68510, United States
    Recruiting
  • Research Site
    Henderson, Nevada 89074, United States
    Recruiting
  • Research Site
    North Las Vegas, Nevada 89086, United States
    Withdrawn
  • Research Site
    Bridgewater, New Jersey 08807, United States
    Withdrawn
  • Research Site
    Jersey City, New Jersey 07302, United States
    Recruiting
  • Research Site
    Somerset, New Jersey 08873, United States
    Recruiting
  • Research Site
    Albany, New York 12208, United States
    Withdrawn
  • Research Site
    Brooklyn, New York 11219, United States
    Recruiting
  • Research Site
    Brooklyn, New York 11220, United States
    Recruiting
  • Research Site
    Clifton Park, New York 12065, United States
    Recruiting
  • Research Site
    Manhasset, New York 11030, United States
    Withdrawn
  • Research Site
    New Windsor, New York 12553, United States
    Withdrawn

Showing the first 100 of 852 sites across 39 countries.

07

References and documents

Publications

  • Bhattacharya CS, Ericsson H, Johansson S, Parkinson J, Boca SM, Yang Y, Heijer M, Housler G, Leonsson-Zachrisson M, Hartleib-Geschwindner J, Pizzato PE. The effect of severe renal impairment on the pharmacokinetics, safety and tolerability of balcinrenone. Br J Clin Pharmacol. 2025 Jul;91(7):1937-1946. doi: 10.1002/bcp.70017. Epub 2025 Feb 17. PubMed 39962632 ↗

Individual participant data

Plan to share: Yes — Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal Vivli.org. All requests will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. "Yes", indicates that AZ are accepting requests for IPD, but this does not mean all requests will be approved.

Supporting information: Study protocol, Sap

08

Registry details

Key details

Study ID
NCT06307652
Lead sponsor
AstraZeneca
Responsible party
Sponsor
First posted
Mar 13, 2024
Start date
Apr 12, 2024
Primary completion
Apr 16, 2027 (estimated)
Completion
Apr 16, 2027 (estimated)
Last update
Sep 11, 2026

Study contacts

AstraZeneca Clinical Study Information Center
Contact
information.center@astrazeneca.com
1-877-240-9479

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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