Meta-Analysis Finds SGLT2 Inhibitors Boost Hemoglobin, Hematocrit in CKD

When treated with sodium-glucose cotransporter 2 (SGLT2) inhibitors, patients with chronic kidney disease (CKD) showed an improvement in anemia markers.¹ Empagliflozin (Jardiance; Boehringer Ingelheim, Eli Lilly) dapagliflozin (Farxiga; AstraZeneca, Bristol-Myers Squibb), and canagliflozin (Invokana; Janssen) effectively increased hemoglobin (Hb) and hematocrit (Hct) levels, according to findings from a systematic review and meta-analysis published in the Journal of Clinical Pharmacy and Therapeutics.

SGLT2 inhibitors have gained recognition for their renal and cardiovascular benefits in patients with CKD. The KDIGO 2024 updated guideline reflects the growing evidence that SGLT2 inhibitors not only slow CKD progression but also reduce cardiovascular risk and improve overall outcomes in this population.² Recommendation 3.7.1 strongly supports the use of SGLT2 inhibitors in patients with type 2 diabetes, chronic kidney disease (CKD), and an estimated glomerular filtration rate (eGFR) of at least = 20 ml/min per 1.73 m².

These findings support the integration of SGLT2 inhibitors into treatment paradigms for patients with CKD.

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Recent studies suggest these drugs may also impact anemia, a prevalent complication in patients with CKD.¹ The authors of the systematic review aimed to evaluate the effects of SGLT2 inhibitors on anemia in this patient population through a meta-analysis of randomized controlled trials. The included randomized controlled trials assessed Hb and Hct levels in patients treated with SGLT2 inhibitors compared with controls. Statistical analyses included fixed-effects and random-effects models, sensitivity analyses, and tests for publication bias.

Of the studies analyzed, 5 focused on Hb levels, comprising 3326 participants treated with SGLT2 inhibitors and 2798 participants in control groups; 3 focused on Hct levels with 1339 participants treated with SGLT2 inhibitors and 785 controls. The meta-analysis results showed that SGLT2 inhibitors significantly increased Hb levels (standard difference in means [SE], −0.350; 95% CI, −0.401 to −0.299) and Hct levels (SE, −0.453; 95% CI, −0.829 to 0.077) compared with controls.

The observed improvements in Hb and Hct levels with SGLT2 inhibitor therapy are consistent with previous findings of renal and cardiovascular protection. Potential mechanisms include enhanced tissue oxygen delivery and diuretic effects reducing plasma volume alongside stimulation of erythropoietin secretion, the authors noted.

Studies suggest varying effects based on treatment duration and dosage. For instance, the authors observed dapagliflozin demonstrated a gradual increase in Hct levels over 4 months, while canagliflozin at 100 mg daily showed sustained increases in Hb and Hct levels over 26 to 52 weeks. Higher doses generally did not significantly improve anemia correction beyond lower doses, indicating minimal incremental benefit.

"The results of our meta-analysis revealed a significant effect of SGLT2 inhibitors in increasing Hb and Hct levels in patients with CKD compared to controls,” the authors concluded. "In particular, the anemia-correcting benefits can be achieved with relatively low doses, minimizing potential toxicity. Therefore, SGLT2 inhibitor treatment is significantly helpful for patients with CKD to correct anemia and its effect on renal or cardiovascular outcomes.”

This comprehensive analysis supports the integration of SGLT2 inhibitors into treatment paradigms for patients with CKD not only for their established benefits but also for their potential in addressing anemia, underscoring their multifaceted therapeutic value in nephrology care, they wrote. Future studies should prioritize addressing heterogeneity in study protocols, including broader participant comorbidities, to enhance understanding of SGLT2 inhibitors' efficacy in treating anemia in CKD. Continued investigation may refine treatment strategies and optimize clinical outcomes for these patients.

References

1. Choi, Hye Duck, Lee, Seung Woo, SGLT2 Inhibitors increase hemoglobin and hematocrit levels in patients with chronic kidney disease: a systematic review and meta-analysis. J Clin Pharm Ther. 2025;2025(1). doi:10.1155/jcpt/4354892

2. Levin A, Ahmed SB, Carrero JJ, et al. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. Kidney Int. 2024;105(4):684-701. doi:10.1016/j.kint.2023.10.016