Recent research has shown that canagliflozin was linked to a 2.1 per cent increase in total iron-binding capacity and improved haemoglobin levels for people with chronic kidney disease and type 2 diabetes.
A new study in Nephrology Dialysis Transplantation has identified a clear role of SGLT2 inhibitors in iron metabolism, and further confirm the consistent clinical benefits of SGLT2 inhibitors across people with type 2 diabetes and chronic kidney disease (CKD).
Lead author Dr Akihiko Koshino said: “In people 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.
“These data suggest iron deficiency, whether absolute or functional, may have an important impact on cardiovascular outcomes in people with CKD or heart failure.”
Researchers assessed the effects of canagliflozin (Invokana, Janssen) on iron metabolism by analysing data from 4,401 adults.
They did this by recording the participant’s transferrin saturation, serum iron, total iron-binding capacity and ferritin levels for patients at baseline and 12 months.
They aimed to find whether iron deficiency impacts the effects of canagliflozin on haemoglobin and cardiorenal outcomes.
More than half of the participants had iron markers measured at baseline, and 38.2 per cent were deficient.
Dr Koshino and colleagues found canagliflozin was associated with a 2.1 per cent increase in total iron-binding capacity (95 per cent CI, 0.4-3.8) and an 11.5 per cent decrease in ferritin (95 per cent CI, 7.1-15.7), without affecting serum iron or transferrin saturation.
Haemoglobin increased by 7.3 g/L (95 per cent CI, 6.2-8.5) and 6.7 g/L (95 per cent CI, 5.2-8.2) during the trial among people 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 authors said: “The effects of SGLT2 inhibitors on iron metabolism and erythropoiesis were not anticipated when these medicines were originally developed. However, it is increasingly recognised that SGLT2 inhibitors have many effects beyond improving glycaemic control including potentially important effects on haematopoiesis.
“These findings identify a clear role of SGLT2 inhibitors in iron metabolism, and further confirm the consistent clinical benefits of SGLT2 inhibitors across people with type 2 diabetes and CKD.”
Click here to access the study.
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