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