Early glomerular filtration rate decline is associated with hemoglobin rise following dapagliflozin initiation in heart failure with reduced ejection fraction
Rev Esp Cardiol (Engl Ed). 2023 Oct;76(10):783-792.
doi: 10.1016/j.rec.2023.03.007.
Epub 2023 Mar 22.
[Article in
English,
Spanish]
Authors
Gema Miñana
1
, Rafael de la Espriella
2
, Patricia Palau
2
, Martina Amiguet
3
, Julia Seller
4
, José Manuel García Pinilla
5
, Eduardo Núñez
6
, José Luis Górriz
2
, Alfonso Valle
4
, Juan Sanchis
1
, Antoni Bayés-Genís
7
, Julio Núñez
1
; en representación de los investigadores del DAPA-VO2
Affiliations
- 1 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España.
- 2 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España.
- 3 Departamento de Medicina, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Universitat Jaume I, Castellón, España.
- 4 Servicio de Cardiología, Hospital de Denia, Alicante, España.
- 5 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.
- 6 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, España. Electronic address: yulnunez@gmail.com.
- 7 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España; Servicio de Cardiología, Hospital Germans Trias i Pujol, Universitat de Barcelona, Badalona, Barcelona, España.
Abstract
Introduction and objectives:
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) induce short-term changes in renal function and hemoglobin. Their pathophysiology is incompletely understood. We aimed to evaluate the relationship between 1- and 3-month estimated glomerular filtration rate (eGFR) and hemoglobin changes following initiation of dapagliflozin in patients with stable heart failure with reduced ejection fraction (HFrEF).
Methods:
This is a post hoc analysis of a randomized clinical trial that evaluated the effect of dapagliflozin on 1- and 3-month peak oxygen consumption in outpatients with stable HFrEF (DAPA-VO2 trial, NCT04197635). We used linear mixed regression analysis to assess the relationship between eGFR and hemoglobin changes across treatment arms.
Results:
A total of 87 patients were evaluated in this substudy. The mean age was 67.0± 10.5 years, and 21 (24.1%) were women. The mean baseline eGFR and hemoglobin were 66.9±20.7mL/min/1.73m2 and 14.3±1.7g/dL, respectively. Compared with placebo, eGFR did not significantly change at either time points in the dapagliflozin group, but hemoglobin significantly increased at 1 and 3 months. At 1 month, the hemoglobin increase was related to decreases in eGFR only in the dapagliflozin arm (P <.001). At 3 months, there was no significant association in either treatment arms (P=.123). Changes in eGFR were not associated with changes in peak oxygen consumption, quality of life, or natriuretic peptides.
Conclusions:
In patients with stable HFrEF, 1-month changes in eGFR induced by dapagliflozin are inversely related to changes in hemoglobin. This association was no longer significant at 3 months.
Keywords:
Cambios en la hemoglobina; Cambios en la tasa de filtrado glomerular estimada; Capacidad funcional máxima; Changes in estimated glomerular filtration rate; Changes in hemoglobin; Dapagliflozin; Dapagliflozina; Heart failure with reduced ejection fraction; Insuficiencia cardiaca con fracción de eyección reducida; Maximal functional capacity.
Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
Publication types
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Randomized Controlled Trial
MeSH terms
-
Aged
-
Benzhydryl Compounds / therapeutic use
-
Female
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Glomerular Filtration Rate
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Heart Failure* / drug therapy
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Hemoglobins / therapeutic use
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Humans
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Male
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Middle Aged
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Quality of Life
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Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use
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Stroke Volume
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Ventricular Dysfunction, Left*
Substances
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dapagliflozin
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Sodium-Glucose Transporter 2 Inhibitors
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Benzhydryl Compounds
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Hemoglobins