Canagliflozin tied to improved iron, hemoglobin levels with type 2 diabetes, CKD
Click Here to Manage Email Alerts
Key takeaways:
- Canagliflozin was associated with a 2.1% increase in total iron-binding capacity.
- Hemoglobin increased by 7.3 g/L for patients with iron deficiency.
Canagliflozin was associated with increased iron utilization and improved hemoglobin levels for adults with type 2 diabetes and chronic kidney disease, according to data published in Nephrology Dialysis Transplantation.
“In patients with dialysis-dependent kidney failure, a proactive high-dose intravenous iron treatment regimen showed a lower risk of major cardiovascular events or death as compared with a reactive low-dose regimen,” Akihiko Koshino, MD, of the department of clinical pharmacy and pharmacology, University Medical Center Groningen at the University of Groningen in The Netherlands, wrote with colleagues. “These data suggest iron deficiency, whether absolute or functional, may have an important impact on cardiovascular outcomes in patients with CKD or heart failure.”
In a post-hoc analysis of the CREDENCE trial, researchers evaluated data from 4,401 adults with type 2 diabetes and CKD to study the effects of the SGLT2 inhibitor canagliflozin (Invokana, Janssen) on iron metabolism.
The researchers recorded serum iron, total iron-binding capacity, transferrin saturation and ferritin levels for patients at baseline and 12 months. They aimed to find whether iron deficiency impacts the effects of canagliflozin on hemoglobin and cardiorenal outcomes.
Of the cohort, 54.9% had iron markers measured at baseline, and 38.2% were deficient.
Koshino and colleagues found canagliflozin was associated with a 2.1% increase in total iron-binding capacity (95% CI, 0.4-3.8) and an 11.5% decrease in ferritin (95% CI, 7.1-15.7), without affecting serum iron or transferrin saturation.
Hemoglobin increased by 7.3 g/L (95% CI, 6.2-8.5) and 6.7 g/L (95% CI, 5.2-8.2) during the trial among patients with and without iron deficiency, respectively. In addition, the effects of canagliflozin on doubling of serum creatinine, kidney failure or death from cardiovascular disease or kidney failure were consistent with or without iron deficiency.
“The effects of SGLT2 inhibitors on iron metabolism and erythropoiesis were not anticipated when these medicines were originally developed,” the researchers wrote. “However, it is increasingly recognized that SGLT2 inhibitors have many effects beyond improving glycemic control including potentially important effects on hematopoiesis. ... These findings identify a clear role of SGLT2 inhibitors in iron metabolism, and further confirm the consistent clinical benefits of SGLT2 inhibitors across diverse patient subsets with type 2 diabetes and CKD.”
Collapse
Click Here to Manage Email Alerts