The Effect of SGLT2 Inhibitor on Renal Anemia in Patients with Moderate to Severe Diabetic Kidney Disease

Background Sodium glucose cotransporter 2 inhibitor (SGLT2i) is a standard treatment for kidney and cardiovascular protection in diabetic kidney disease (DKD). Recent evidence suggests that SGLT2i may enhance erythropoiesis, but data are limited in advanced kidney disease. Methods We reviewed 670 DKD patients started on SGLT2i. Their hemoglobin level and estimated glomerular filtration rate (eGFR) 6 months before the use of SGLT2i, immediately before, and 6 months after the use of SGLT2i were reviewed. Results The hemoglobin level had a small but significant increase 6 months after SGLT2 inhibitor treatment from 12.89 ± 1.75 to 13.08 ± 1.94 g/dL (p < 0.0001). The absolute increase in hemoglobin was 0.19 ± 1.06 g/dL; 117 patients (17.5%) had an increase ≥1.0 g/dL. In contrast, the average hemoglobin level was 13.01 ± 1.75 g/dL 6 months before SGLT2i, which showed a significant decline to the pre-treatment level (p=0.001). The increase in hemoglobin after SGLT2i was most marked in CKD stage 3b (12.26 ± 1.81 to 12.68 ± 1.98 g/dL, p < 0.0001). There was no significant correlation between the change in hemoglobin level and the severity of baseline albuminuria, eGFR, or HbA1c level, but it had significant correlations with the change in eGFR (r = -0.172, p < 0.0001) and HbA1c (r = 0.120, p = 0.004) during the same period. Conclusion SGLT2 inhibitor therapy leads to a small but significant increase in hemoglobin level in patients with T2DM, including those with moderate to severe CKD.