Effects of SGLT2 inhibitors on anemia in patients with diabetes and chronic kidney disease: A population-based cohort study using target trial emulation framework
MSc student Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)
Background: Anemia frequently occurs in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), which may also increase the risk of cardiovascular diseases. Sodium-glucose transport protein 2 (SGLT2) inhibitors have been reported to reduce the risk of anemia from the post-hoc analyses of clinical trials. However, the association between SGLT2 inhibitors and anemia in clinical practice is still limited.
Objectives: To evaluate the effects of SGLT2 inhibitors on anemia among patients with T2D and CKD in Taiwan.
Methods: We conducted a retrospective cohort study using a target trial emulation framework and analyzed the largest multi-institutional electronic medical records database in Taiwan from 2016 to 2022. We included patients with T2D and CKD stage 1-3 newly receiving SGLT2 inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) . The composite outcome was the initiation of anemia treatment including iron preparations (IPs), and erythropoiesis-stimulating agents (ESAs). The hazard ratio (HR) and 95% confidence interval (CI) were derived using Cox proportional hazards model with adjustment of age and sex to compare the risk of anemia in two treatment groups.
Results: We initially identified a total of 19,884 and 1,725 patients with T2D and CKD stage 1-3 newly receiving SGLT2 inhibitors and GLP-1 RAs, respectively. The 56 % were male, and the mean [SD] age, HbA1c, eGFR, and hemoglobin were 58.2 [9.2] years, 8.4 [1.7] %, 68.9 [14.9] ml/min/1.73m2, and 13.3 [2.1] g/dL. Compared to GLP1 RAs, SGLT2 inhibitors were associated with a lower risk of initiation in anemia treatments (adjusted HR [95% CI] 0.59 [0.46-0.76]). In terms of outcomes for IPs and ESAs, we observed decreased risk at adjusted HR [95% CI] 0.67 [0.50-0.90], and 0.37 [0.26-0.53], respectively.
Conclusions: Compared with GLP1 RAs, we found that the use of SGLT2 inhibitors was associated with a lower risk of initiation in anemia treatments. Further research investigating the management of anemia using SGLT2i is imperative.
