Pathogenetic aspects of the influence of gliflozins on erythropoiesis and iron metabolism in patients with chronic heart failure

Background. Sodium glucose cotransporter type 2 (SGLT2) inhibitors, established over the past decade, including dapagliflozin, empagliflozin, and canagliflozin, have demonstrated significant reductions in hospitalization and mortality in patients with diabetes mellitus and chronic heart failure in a series of randomized trials. Drugs in this group have a unique hypoglycemic mechanism of action, restoring renal regulation of blood sugar levels, and are also characterized by a low risk of developing undesirable effects and are well tolerated by patients. Along with a wide range of positive effects of gliflozins on the condition of patients and an improvement in the overall prognosis of the disease, data on a decrease in iron levels in the blood during long-term use of drugs in this group have increasingly appeared in the literature.

Objective. To evaluate the pathogenetic aspects of the influence of gliflozins on erythropoiesis and iron metabolism in patients suffering from chronic heart failure and diabetes mellitus.

Materials and methods. An analysis of foreign sources was carried out, which studied the effect of the use of SGLT2 inhibitors on erythropoiesis and iron metabolism in patients with chronic heart failure. This review examines the pathogenetic basis of the dynamics of hematopoiesis in patients with diabetes mellitus and chronic heart failure. Changes in hematocrit, hemoglobin, reticulocyte count, and erythropoietin reported in prospective analyzes are analyzed.

Conclusion. The increase in hemoglobin levels observed when taking gliflozins improves tissue oxygenation, thereby providing some protective effect (in particular, cardioprotective and nephroprotective effects). However, the active use of iron in the process of erythropoiesis leads to an increase in the levels of soluble transferrin receptors and iron-binding capacity of the blood serum in combination with a decrease in ferritin, transferrin saturation coefficient and hepcidin. Thus, long-term use of SGLT2 inhibitors, with a positive effect on hemoglobin levels, can lead, at a minimum, to latent iron deficiency, which requires monitoring of a clinical blood test and a biochemical blood test to study iron metabolism in patients taking gliflozins. To understand the significance of this problem, it is necessary to initiate large-scale cohort studies.

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