The effect of sodium-glucose cotransporter-2 inhibitors on haemoglobin and haematocrit in diabetic kidney disease

Karaköse, Süleyman; Doğan, Beyza; Ergül, Fatih; Güney, İbrahim

doi:10.1590/1806-9282.20251460

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ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 72 (3) • 2026 • https://doi.org/10.1590/1806-9282.20251460 linkcopy

The effect of sodium-glucose cotransporter-2 inhibitors on haemoglobin and haematocrit in diabetic kidney disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: The aim of this study was to evaluate the impact of sodium-glucose cotransporter-2 inhibitors on haematological parameters and other clinical markers in this patient population.

METHODS: We retrospectively analyzed the medical records of 150 diabetic patients with chronic kidney disease who initiated sodium-glucose cotransporter-2 inhibitor therapy, comparing their baseline and 3-month post-treatment laboratory and clinical data.

RESULTS: Following 3 months of treatment with sodium-glucose cotransporter-2 inhibitors, mean haemoglobin and haematocrit levels significantly increased, even in patients with an estimated glomerular filtration rate below 60 mL/min/1.73 m². This therapy also led to significant reductions in the spot urine albumin-to-creatinine ratio, as well as in both systolic and diastolic blood pressure.

CONCLUSION: Sodium-glucose cotransporter-2 inhibitor therapy was associated with significant increases in haemoglobin and haematocrit levels in diabetic patients with chronic kidney disease. These findings suggest that sodium-glucose cotransporter-2 inhibitors may represent a potential area requiring further investigation for the treatment of anaemia associated with diabetic chronic kidney disease.

KEYWORDS:
Anaemia; Dapagliflozin; Empagliflozin; Chronic kidney disease

Parameters	Baseline (n=150)	At the third month (n=150)	p
Cre (mg/dL)	1.1 (0.49–2.14)	1.20 (0.55–2.62)	<0.001
eGFR (mL/min)	60.5 (30–130)	58.5 (21–133)	<0.001
K+ (mmol/l)	4.8 (3.2–6.0)	4.6 (3.5–5.8)	0.06
Hb (g/dL)	13.54±1.74	14.03±1.77	<0.001
Hct	41.09±5.04	42.99±4.63	<0.001
MCV	86.66±4.71	85.95±5.54	0.028
WBC	8,325 (864–16,200)	8,065 (1,040–16,640)	0.656
Glucose (mg/dL)	143 (59–350)	141 (61–418)	0.358
HbA1c	7.6 (5–14.9)	7.5 (5–12.6)	<0.001
CRP	2.0 (0–31)	2.0 (0–99)	0.124
Albuminuria (mg/dL)	204.5 (0–5,480)	81 (0–6,259)	<0.001
SBP (mmHg)	147 (99–194)	135 (100–184)	<0.001
DBP (mmHg)	80 (60–121)	76 (50–109)	<0.001

	Dapagliflozin (n=101)	Empagliflozin 10/25 (n=49)	Empagliflozin 10 (n=23)	Empagliflozin 25 (n=26)
Cre
Baseline	1.10 (0.56–2.14)	1.15±0.32	1.23±0.33	1.09±0.33
Third month	1.22 (0.55–2.62)	1.21±0.38	1.24±0.34	1.19±0.40
p	<0.001	0.019	0.748	0.002
eGFR
Baseline	61 (30–118)	57 (30–130)	54 (30–130)	57.5 (34–109)
Third month	58 (21–113)	59 (26–133)	52 (30–133)	59.5 (29–104)
p	<0.001	0.114	0.917	0.290
K+
Baseline	4.75±0.48	4.71±0.47	4.50 (4.0–5.5)	4.95 (3.2–5.4)
Third month	4.61±0.49	4.66±0.45	4.4 (3.7–5.3)	4.90 (4.2–5.5)
p	0.001	0.390	0.300	0.406
Hb
Baseline	13.51±1.68	13.66±1.84	13.31±1.92	13.96±1.76
Third month	13.96±1.71	14.20±1.87	13.87±1.98	14.50±1.75
p	<0.001	<0.001	0.003	0.001
Hct
Baseline	40.94±5.25	41.41±4.60	40.94±4.79	41.83±4.47
Third month	42.84±4.52	43.30±4.88	42.46±5.24	44.04±4.51
p	<0.001	<0.001	0.010	<0.001
HbA1c
Baseline	7.92±1.85	8.1±1.43	8.3 (5.6–11.3)	8.3 (6.0–10.8)
Third month	7.61±1.48	7.74±1.38	7.5 (5.6–12.6)	7.7 (6.1–9.9)
p	0.007	0.007	0.217	0.010
Albuminuria
Baseline	259 (0–4,817)	80 (0–5,480)	51.5 (0–3,417)	102 (0–5,480)
Third month	111 (0–6,259)	10 (0–4,490)	3 (0–4,490)	39 (0–1,885)
p	<0.001	0.005	0.209	0.005
SBP
Baseline	147.1±20.2	147.7±20.8	144.4±22.9	150.6±18.8
Third month	135.5±18.6	137.4±21.3	131.9±23.7	142.3±18.0
p	<0.001	<0.001	<0.001	0.019
DBP
Baseline	81.4±10.6	80.5±8.1	78.7±5.9	82.1±9.4
Third month	76.7±10.3	76.3±9.1	73.8±7.5	78.5±0.9
p	<0.001	0.003	0.003	0.120

Parameters	Baseline	At the third month	p
Cre
Dapagliflozin (n=45)	1.42±0.29	1.53±0.41	0.004
Empagliflozin 10/25 mg (n=27)	1.40 (1.0–1.78)	1.54 (0.9–1.91)	0.046
eGFR
Dapagliflozin (n=45)	47 (30–58)	41 (21–83)	0.008
Empagliflozin 10/25 mg (n=27)	50 (30–58)	43 (29–82)	0.118
Potassium
Dapagliflozin (n=45)	4.88±0.53	4.66±0.58	0.003
Empagliflozin 10/25 mg (n=27)	4.7 (3.2–5.4)	4.66 (3.7–5.5)	0.198
Hb
Dapagliflozin (n=45)	13.15±1.57	13.49±1.72	0.010
Empagliflozin 10/25 mg (n=27)	13.12±1.55	13.73±1.67	<0.001
Hct
Dapagliflozin (n=45)	40.31±4.53	41.60±4.48	0.001
Empagliflozin 10/25 mg (n=27)	39.77±3.99	41.94±4.50	<0.001
Albuminuria
Dapagliflozin (n=45)	318.5 (0–4,817)	120.5 (0–6,259)	0.003
Empagliflozin 10/25 mg (n=27)	99.5 (0–3,417)	27.5 (0–4,490)	0.390
SBP
Dapagliflozin (n=45)	150.6±21.3	137.9±18.8	<0.001
Empagliflozin 10/25 mg (n=27)	149.6±20.9	138.2±20.9	0.002
DBP
Dapagliflozin (n=45)	80.9±12.2	75.3±10.9	0.001
Empagliflozin 10/25 mg (n=27)	78.4±8.0	76.7±9.2	0.333

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[1] Cre: creatinine; GFR: estimated glomerular filtration rate; K⁺: potassium; MCV: mean corpuscular volume; Hb: haemoglobin; Hct: haematocrit; WBC: white blood cell; CRP: C-reactive protein; SBP: systolic blood pressure; DBP: diastolic blood pressure. Italic values indicate statistical significance (p<0.05).