Effect of Dapagliflozin on hemoglobin level in heart failure patients with chronic kidney disease and/or diabetes
Background: Heart failure is a complex clinical syndrome caused by any functional or structural cardiac disease that reduces the ventricle's ability to fill or pump blood. Anemia is frequent in patient with heart failure and is associated with deterioration through the activation of neuro-hormonal pathways. Dapagliflozin is a selective and reversible inhibitor of Sodium-glucose co-transporter-2 (SGLT2). Dapagliflozin increases hemoglobin level through different mechanisms such increasing plasma concentration by diuresis or increasing Erythropoietin synthesis.
Objective: To evaluate the effect of additional dapagliflozin into conventional therapy on hemoglobin in heart failure patients with chronic kidney disease (CKD) with or without diabetes mellitus DM.
Patients and Methods: This was prospective clinical study conducted at medical wards at Nasiriya Heart Center during the period from the 1st November / 2021 to the end of July / 2022. The research was conduct on 120 participants with heart failure and renal impairment. The patients were divided into two groups. The first group included 60 patients who were administered dapagliflozin in addition to conventional medication and the other group consisted of 60 patients who received only conventional therapy. Both groups were matched regarding socio-demographic characteristics. Hemoglobin concentration, was recorded on day 1 as a baseline visit then followed up after four months.
Results: Before treatment there were no significant differences in sociodemographic and clinical parameters between the two groups. In the dapagliflozin group, hemoglobin level was significantly higher than pre-therapeutic level (12.53 g/L vs 11.85 g/L, P= 0.016).patients in the control group had significantly lower mean level of hemoglobin after treatment compared to baseline level (11.88 g/L vs 12.56 g/L, P= 0.001).
Conclusion: The study shows that dapagliflozin increases the concentration of hemoglobin and correct anemia in patients with heart failure with CKD compared to the control group.
Heidenreich, P. A. , et al. (2022) “2022 AHA/ACC/HFSA guideline for the Management of Heart Failure: Executive summary: A report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines,” Circulation, 145(18), pp. e876–e894. doi: 10.1161/CIR.0000000000001062.
- Mcdonagh, T. A. , et al. (2021) “ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC,” European heart journal, 42(36), pp. 3599–3726
_ Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nature Reviews Cardiology. 2011 Jan;8(1):30-41.
-McMurray JJ, Stewart S. Epidemiology, aetiology, and prognosis of heart failure. Heart. 2000 May 1;83(5):596-602.
_Ahmed, A. and Campbell, R. C. (2008) “Epidemiology of chronic
-Shah R, Agarwal AK. Anemia associated with chronic heart failure: kidney disease in heart failure,”. Heart failure clinics, 4(4), pp. 387–399. doi: 10.1016/j.hfc.2008.03.0087_
- Docherty KF, Curtain JP, Anand IS, Bengtsson O, Inzucchi SE, Køber L,. Effect of dapagliflozin on anaemia in DAPA‐HF. European Journal of Heart Failure. 2021 Apr;23(4):617-28
_Nicholson, M. K., Asswad, R. and Wilding, J. P. (2021) “Dapagliflozin for the treatment of type 2 diabetes mellitus-an update,” Expert opinion on pharmacotherapy, 22(17), pp. 2303–2310.
- 9_Cowie MR, Fisher M. SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nature Reviews Cardiology. 2020 Dec;17(12):761-72
_Heerspink, H. J. L. et al. (2016) “Sodium glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: Cardiovascular and kidney effects, potential mechanisms, and clinical applications: Cardiovascular and kidney effects, potential mechanisms, and clinical applications,” Circulation, 134(10), pp. 752–772. doi: 10.1161/CIRCULATIONAHA.116.021887.
- Qu W, Yao L, Liu X, Xu T, Tian B. Effects of sodium-glucose co-transporter 2 inhibitors on hemoglobin levels: A meta-analysis of randomized Controlled Trials. Front Pharmacol [Internet]. 2021;12. Available from: http://dx.doi.org/10.3389/fphar.2021.630820
- Mohammed MQ, Hussein MF, Essa SI, Dahaam YS, Ismaeel AA. Echocardiographic evaluation of the right ventricular function in a sample of Iraqi patients with left ventricular dysfunction. World Heart Journal. 2019 Oct 1;11(4):301-9.
- Hassanin A, Hassanein M, Bendary A, Maksoud MA. Demographics, clinical characteristics, and outcomes among hospitalized heart failure patients across different regions of Egypt. The Egyptian Heart Journal. 2020 Dec;72(1):1-9.
-Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou F-F, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med [Internet]. 2020;383(15):1436–46. Available from: http://dx.doi.org/10.1056/nejmoa2024816
- Ding N, Shah AM, Blaha MJ, Chang PP, Rosamond WD, Matsushita K. Cigarette smoking, cessation, and risk of heart failure with preserved and reduced ejection fraction. J Am Coll Cardiol [Internet]. 2022;79(23):2298–305.
- Csige I, Ujvárosy D, Szabó Z, Lőrincz I, Paragh G, Harangi M, et al. The impact of obesity on the cardiovascular system. J Diabetes Res [Internet]. 2018;2018:1–12.
-Curtain JP, Docherty KF, Jhund PS, Petrie MC, Inzucchi SE, Køber L, et al. Effect of dapagliflozin on ventricular arrhythmias, resuscitated cardiac arrest, or sudden death in DAPA-HF. Eur Heart J [Internet]. 2021;42(36):3727–38
_ Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo AP, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet [Internet]. 2018;391(10120):572–80. Available from: http://dx.doi.org/10.1016/s0140-6736(17)32520-5
- Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail [Internet]. 2020;22(8):1342–56.
_Tackling G, Borhade MB. Hypertensive heart disease. In: StatPearls [Internet]. StatPearls Publishing; 2022.
- Ghanim, H. , et al. (2020) ‘Dapagliflozin suppresses hepcidin and increases erythropoiesis’, Journal of Clinical Endocrinology and Metabolism, 105(4), pp. E1056–E1063. Available at: https://doi.org/10.1210/clinem/dgaa057
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