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In the treatment of heart failure (HF), SGLT-2 inhibitor (SGLT-2i) can significantly improve the clinical outcome and quality of life related to HF. The current data show that SGLT-2i is effective and safe in improving HF outcomes in patients with chronic kidney disease (CKD) stage 4, but there is little clinical evidence in patients with eGFR<20 ml/min/1.73 m2. Therefore, our research is designed to confirm that SGLT-2i can improve the outcome of HF in patients with chronic heart failure with reduced ejection fraction (HFrEF) and severe chronic renal insufficiency (eGFR<20ml/min/1.73m2).

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