Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Hemoglobinand Hematocrit: A Retrospective Analysis (SGLT-2 Inhibitors &Hemoconcentration)

Abstract

Background: Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors, such as Dapagliflozin and Empagliflozin, are a class of medications used in the
management of type 2 diabetes mellitus and, more recently, heart failure and chronic kidney disease. An observed secondary effect of these drugs is anincrease in hematocrit (Hct) and hemoglobin (Hb) levels. The mechanisms and clinical significance of these changes are still under investigation. Largecardiovascular outcome trials did not demonstrate a consistent signal for increased thromboembolic events; details on this subject will be mentioned in thediscussion section. This study aims to analyze the effect of dapagliflozin and empagliflozin treatment on Hct and Hb in a cohort of 97 patients in our hospital.

Methods: We conducted a retrospective analysis of a dataset containing information on 97 patients treated with either Dapagliflozin (n = 58) or Empagliflozin(n = 39). The dataset included baseline and 3–6-month follow-up measurements of Hct and Hb, along with demographic and clinical data such as age, BMI,smoking status, and diabetes mellitus (DM) status.

Results: Both Dapagliflozin and Empagliflozin were associated with a numerical increase in mean Hct and Hb levels over a 3–6-month period. The increasein hemoglobin/hematocrit was statistically significant for the Empagliflozin group (p = 0.0107), but not for the Dapagliflozin group (p = 0.0642). Therewas no statistically significant difference in the magnitude of change in either Hct or Hb between the two drug classes. ANOVA revealed a significantdifference in Hct change across different dose groups (p = 0.0327), with Dapagliflozin 10mg and Empagliflozin 25mg showing the largest increases. Asignificant negative correlation was found between baseline hematological parameters and their subsequent change, suggesting a greater effect in patientswith lower baseline values.

Conclusion: This analysis supports existing evidence that SGLT2 inhibitors increase hematocrit and hemoglobin. The effect on hematocrit is dose-dependentand slightly more noticeable with Empagliflozin. These findings add to the growing body of knowledge on the pleiotropic effects of SGLT2 inhibitors andhighlight the need for further studies to elucidate the mechanisms underlying these hematological changes and their long-term clinical implications.