SGLT2 Inhibitors Can Improve Anemia in Patients with CKD

Sherzod Abdullaev, MD
Credit: European Renal Association

New data presented at the 61st European Renal Association Congress is elucidating the role and effects of SGLT2 inhibitor use in people with chronic kidney disease (CKD).

A prospective study examining use of dapagliflozin (Farxiga) in patients with anemia and CKD, results of the study suggest use SGLT2 inhibitors could reduce risk of anemia among these patients even without the presence of iron supplements or erythropoietin therapy.¹

“The use of dapagliflozin for 8 months resulted in a significant elevation in hemoglobin levels in patients with CKD. Further studies can explore of better understanding of the effect and confirm the mechanisms that explain this finding,” wrote investigators.¹

Few areas have seen the same revolution in therapeutic options as nephrology in the last decade. In CKD, this has been driven in large part due to the development of the SGLT2 inhibitor class. Based on previous research, the field has begun to hypothesize about a potential benefit on anemia among patients with CKD, which could stand to have a significant benefit on patients with approximately 14% of US patients with CKD also dealing with anemia.^1,2

A study assessing the effects of SGLT2 and GLP-1 RA from the CREDENCE and DAPA-CKD trials published in JAMA Network Open in March 2024 found SGLT2 inhibitors were associated with a lower incidence of anemia events (HR, 0.79; 95% CI, 0.71 to 0.87) but not with a lower rate of anemia treatment initiation (HR, 0.99; 95% CI, 0.83 to 1.19) among patients with type 2 diabetes and CKD.³

In the current study, Sherzod Abdullaev, MD, of the Republican Specialized Scientific and Practical Medical Center of Nephrology and Kidney Transplantation, and Ranokhon Igamberdieva, MD, of Tashkent Pediatric Medical Institute, sought to better understand the effects of SGLT2 inhibitors in patients with anemia and CKD. With this in mind, investigators designed a single-center, prospective study of patients with eGFR of 30 to 90 mL/min/1.73m2 who received dapagliflozin 10 mg daily between June 2022 and October 2023.¹

The primary outcome of interest for the study was the mean difference in hemoglobin levels 5 months prior and 8 months after initiation.¹

Overall, 132 patients underwent screening as part of the study protocol. Among this group, 53 were prescribed dapagliflozin. This cohort had a mean eGFR at screening of 53.2 mL/min/1.73m2 and 52.7% were men. Investigators highlighted 0 patients received iron supplements or erythropoietin therapy.¹

Upon analysis, investigators discovered the mean Hb level 5 months prior to initiating SGLT2 inhibitor therapy was 10.5 g/dL and patients experienced a mean loss of Hb of 0.10 g/dL (95% CI, -0.22 to 0.06) over the course of the 5-month per-SGLT2 inhibitor observation period.¹

Following the initiation of dapagliflozin, patients experienced a mean Hb increase of 1.03 (95% CI, 0.84 to 1.14) g/dL. Further analysis revealed the mean Hb difference in before and after initiating SGLT2 inhibitor therapy was 1.13 (95% CI, 0.84 to 1.41; P <.01) g/dL.¹

“Elevation of hemoglobin with SGLT2is may be closely linked to the reduction of cardiovascular mortality and heart failure,” investigators concluded.¹

References:

1. Abdullaev S, Igamberdieva R. The Effect of Dapagliflozin on Anemia in Patients with CKD. Abstract presented at 61st European Renal Association Congress. Stockholm, Sweden. May 23-26, 2024.
2. Bishaw F, Belay Woldemariam M, Mekonen G, Birhanu B, Abebe A. Prevalence of anemia and its predictors among patients with chronic kidney disease admitted to a teaching hospital in Ethiopia: A hospital-based cross-sectional study. Medicine (Baltimore). 2023;102(6):e31797. doi:10.1097/MD.0000000000031797
3. Hu J, Shao S, Tsai DH, Chuang AT, Liu K, Lai EC. Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients With Diabetes and CKD. JAMA Netw Open. 2024;7(3):e240946. doi:10.1001/jamanetworkopen.2024.0946