Marques Pedro, Matias Paula, Travlos Christoforos K, Angélico-Gonçalves António, Diniz Hugo, Vasques-Nóvoa Francisco, Packer Milton, Friões Fernando, Tsoukas Michael A, Mavrakanas Thomas A, Sharma Abhinav, Ferreira João Pedro
Internal Medicine Department, Unidade Local de Saúde de São João, Porto, Portugal.
Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal.
Clin Res Cardiol. 2025 May 27. doi: 10.1007/s00392-025-02685-6.
Anemia and iron deficiency are common in heart failure (HF) and chronic kidney disease (CKD). These conditions are associated with upregulation of hepcidin, which impairs the enteric absorption of iron, limiting the use of oral iron formulations in these populations. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are associated with enhanced erythropoiesis and have been shown to augment the erythropoietic response to intravenous iron. The effect of baseline SGLT2i therapy in the erythropoietic response following oral iron supplementation is currently not known.
To compare the erythropoietic response to oral iron supplementation in patients with HF or CKD, using and not using SGLT2i as background therapy.
This is a retrospective analysis of ambulatory patients with HF or CKD followed in cardio-kidney-metabolic clinics from a quaternary care hospital in Canada and a tertiary care hospital from Portugal. An age- and sex-matched population of patients using (n = 76) and not using (n = 76) a SGLT2i was compared for changes in hemoglobin and hematocrit following oral iron supplementation. Secondary outcomes included changes in iron biomarkers, natriuretic peptides and kidney function.
Overall, the mean age was 75 ± 9 years, 49% were men, 119 (78%) had CKD, 107 (70%) HF, and 113 (74%) had anemia. After adjustment for baseline differences, SGLT2i users experienced a greater increase in hemoglobin and hematocrit compared to SGLT2i non-users: hemoglobin + 0.80 g/dL (95% confidence interval [CI] 0.39-1.21 g/dL, p < 0.001); hematocrit + 3.0% (95% CI 1.0-4.0%, p < 0.001). No significant differences on iron biomarkers or any of the secondary outcomes were found between the groups.
Oral iron supplementation in patients with background therapy including a SGLT2i (vs. SGLT2i non-users) was associated with a greater increase in hemoglobin and hematocrit. These results suggest that patients with HF or CKD patients treated with SGLT2i might have an enhanced erythropoietic response to oral iron supplementation.
贫血和缺铁在心力衰竭（HF）和慢性肾脏病（CKD）中很常见。这些情况与铁调素上调有关，铁调素会损害肠道对铁的吸收，限制这些人群口服铁剂的使用。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）与红细胞生成增强有关，并且已被证明可增强对静脉铁剂的红细胞生成反应。目前尚不清楚基线SGLT2i治疗对口服铁剂补充后红细胞生成反应的影响。
比较使用和不使用SGLT2i作为背景治疗的HF或CKD患者对口服铁剂补充的红细胞生成反应。
这是一项对加拿大一家四级护理医院和葡萄牙一家三级护理医院的心肾代谢门诊随访的HF或CKD门诊患者的回顾性分析。比较了年龄和性别匹配的使用（n = 76）和未使用（n = 76）SGLT2i的患者群体在口服铁剂补充后血红蛋白和血细胞比容的变化。次要结局包括铁生物标志物、利钠肽和肾功能的变化。
总体而言，平均年龄为75±9岁，49%为男性，119例（78%）患有CKD，107例（70%）患有HF，113例（74%）患有贫血。在对基线差异进行调整后，与未使用SGLT2i的患者相比，使用SGLT2i的患者血红蛋白和血细胞比容的增加更大：血红蛋白增加+0.80 g/dL（95%置信区间[CI] 0.39 - 1.21 g/dL，p < 0.001）；血细胞比容增加+3.0%（95% CI 1.0 - 4.0%，p < 0.001）。两组之间在铁生物标志物或任何次要结局方面均未发现显著差异。
在包括SGLT2i的背景治疗患者中（与未使用SGLT2i的患者相比），口服铁剂补充与血红蛋白和血细胞比容的更大增加有关。这些结果表明，接受SGLT2i治疗的HF或CKD患者可能对口服铁剂补充有增强的红细胞生成反应。
