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The effect of SGLT-2i administration on red blood cell distribution width in patients with heart failure and type 2

Nikolaos Katsiadas1, Andrew Xanthopoulos2, Grigorios Giamouzis2

  • 1Department of Cardiology, Konstantopoulio General Hospital, Nea Ionia, Greece.

Frontiers in Cardiovascular Medicine
|October 17, 2022
PubMed

Insights

Sodium glucose co-transporter-2 inhibitors (SGLT-2i) increased red blood cell distribution width (RDW) in patients with heart failure and type 2 diabetes. This RDW increase, linked to erythropoietin, may indicate improved erythropoiesis and is associated with better patient outcomes.

Area of Science:

  • Cardiology
  • Endocrinology
  • Hematology

Background:

  • Sodium glucose co-transporter-2 inhibitors (SGLT-2i) show benefits in heart failure (HF) and type 2 diabetes mellitus (DM).
  • A proposed mechanism involves erythropoietin (EPO)-stimulated erythropoiesis and increased hematocrit.
  • Red blood cell distribution width (RDW) reflects red blood cell size heterogeneity and is linked to EPO.

Purpose of the Study:

  • To investigate the effect of SGLT-2 inhibitors on RDW in patients with HF and DM.
  • To explore the relationship between RDW changes, EPO levels, and clinical outcomes.

Main Methods:

  • A prospective, single-center study involving 110 patients with HF and DM.
  • Random assignment to dapagliflozin (SGLT-2i) or a control group.
  • Evaluation of RDW, EPO, ferritin, and folic acid at baseline, 6, and 12 months; logistic regression for outcome prediction.

Main Results:

  • RDW significantly increased in the dapagliflozin group at 6 and 12 months (p < 0.001).
  • RDW increase correlated positively with EPO and negatively with ferritin and folic acid (p < 0.005).
  • Baseline RDW was independently associated with 1-year death or HF rehospitalization.

Conclusions:

  • SGLT-2i (dapagliflozin) administration leads to increased RDW in patients with HF and DM.
  • This RDW elevation may be attributed to SGLT-2i-induced hemopoiesis.
  • Baseline RDW is a significant independent predictor of adverse outcomes in this patient population.
Abstract

Keywords:
agingerythropoietinmechanismsoxidative stressred blood cell distribution widthsodium glucose co-transporter-2 inhibitors

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