Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España.
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España.
Rev Esp Cardiol (Engl Ed). 2023 Oct;76(10):783-792. doi: 10.1016/j.rec.2023.03.007. Epub 2023 Mar 22.
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) induce short-term changes in renal function and hemoglobin. Their pathophysiology is incompletely understood. We aimed to evaluate the relationship between 1- and 3-month estimated glomerular filtration rate (eGFR) and hemoglobin changes following initiation of dapagliflozin in patients with stable heart failure with reduced ejection fraction (HFrEF).
This is a post hoc analysis of a randomized clinical trial that evaluated the effect of dapagliflozin on 1- and 3-month peak oxygen consumption in outpatients with stable HFrEF (DAPA-VO trial, NCT04197635). We used linear mixed regression analysis to assess the relationship between eGFR and hemoglobin changes across treatment arms.
A total of 87 patients were evaluated in this substudy. The mean age was 67.0± 10.5 years, and 21 (24.1%) were women. The mean baseline eGFR and hemoglobin were 66.9±20.7mL/min/1.73m and 14.3±1.7g/dL, respectively. Compared with placebo, eGFR did not significantly change at either time points in the dapagliflozin group, but hemoglobin significantly increased at 1 and 3 months. At 1 month, the hemoglobin increase was related to decreases in eGFR only in the dapagliflozin arm (P <.001). At 3 months, there was no significant association in either treatment arms (P=.123). Changes in eGFR were not associated with changes in peak oxygen consumption, quality of life, or natriuretic peptides.
In patients with stable HFrEF, 1-month changes in eGFR induced by dapagliflozin are inversely related to changes in hemoglobin. This association was no longer significant at 3 months.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）可引起肾功能和血红蛋白的短期变化。其病理生理学尚未完全阐明。我们旨在评估依帕列净治疗稳定射血分数降低的心力衰竭（HFrEF）患者后 1 个月和 3 个月估算肾小球滤过率（eGFR）和血红蛋白变化之间的关系。
这是一项随机临床试验的事后分析，该试验评估了依帕列净对稳定 HFrEF 门诊患者 1 个月和 3 个月峰值耗氧量的影响（DAPA-VO 试验，NCT04197635）。我们使用线性混合回归分析评估了治疗组之间 eGFR 和血红蛋白变化之间的关系。
共有 87 例患者在这项亚研究中进行了评估。平均年龄为 67.0±10.5 岁，21 例（24.1%）为女性。平均基线 eGFR 和血红蛋白分别为 66.9±20.7mL/min/1.73m 和 14.3±1.7g/dL。与安慰剂相比，依帕列净组在两个时间点的 eGFR 均无显著变化，但血红蛋白在 1 个月和 3 个月时显著增加。在 1 个月时，只有依帕列净组的血红蛋白增加与 eGFR 下降相关（P<0.001）。在 3 个月时，两个治疗组之间没有显著关联（P=0.123）。eGFR 的变化与峰值耗氧量、生活质量或利钠肽无相关性。
在稳定的 HFrEF 患者中，依帕列净引起的 eGFR 在 1 个月时的变化与血红蛋白的变化呈负相关。这种相关性在 3 个月时不再显著。
