SGLT2 Inhibitors Increase Hemoglobin and Hematocrit Levels in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Abstract

What Is Known and Objective: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve renal and cardiovascular outcomes and have been reported to have a positive impact on anemia, a common and challenging condition in patients with chronic kidney disease (CKD). The aim of this study is to evaluate the effects of SGLT2 inhibitors on anemia in patients with CKD.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials. Changes in hemoglobin (Hb) and hematocrit (Hct) levels were assessed in participants treated with SGLT2 inhibitors—empagliflozin, dapagliflozin, or canagliflozin—and compared with those receiving control treatments. Statistical analyses were performed using a fixed-effects model or a random-effects model, depending on the heterogeneity. Sensitivity analyses were also conducted to evaluate the impact of each study on the meta-analysis. Publication bias was examined using Begg’s and Egger’s tests.

Results and Discussion: Five studies assessing Hb levels were included. SGLT2 inhibitors significantly increased Hb levels compared with controls (standard difference in means [SE] = −0.350; 95% confidence interval [CI] −0.401–−0.299). Similarly, in three studies evaluating Hct levels, SGLT2 inhibitors significantly increased Hct levels compared with controls (SE = −0.453; 95% CI −0.829–0.077).

What Is New and the Conclusions: This systematic review confirms that SGLT2 inhibitors effectively improve anemia in patients with CKD. We recommend considering SGLT2 inhibitors as a treatment option for CKD patients, not only for their renal and cardiovascular benefits but also for their reliability in addressing anemia.