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Marques P, Matias P, Packer M, Vieira JT, Vasques-Nóvoa F, Sharma A, Mavrakanas TA, Friões F, Ferreira JP. Erythropoietic response after intravenous iron in patients with heart failure and reduced ejection fraction with and without background treatment with sodium-glucose cotransporter 2 inhibitors. Eur J Heart Fail 2023; 25:2191-2198. [PMID: 37559543 DOI: 10.1002/ejhf.2992] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
AIMS Intravenous (IV) iron increases haemoglobin/haematocrit and improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) also increase haemoglobin/haematocrit and improve outcomes in heart failure by mechanisms linked to nutrient deprivation signalling and reduction of inflammation and oxidative stress. The effect of IV iron among patients using SGLT2i has not yet been studied. The aim of this study was to evaluate the changes in haemoglobin, haematocrit, and iron biomarkers in HFrEF patients treated with IV iron with and without background SGLT2i treatment. Secondary outcomes included changes in natriuretic peptides, kidney function and heart failure-associated outcomes. METHODS AND RESULTS Retrospective, single-centre analysis of HFrEF patients with iron deficiency treated with IV iron using (n = 60) and not using (n = 60) SGLT2i, matched for age and sex. Mean age was 73 ± 12 years, 48% were men, with more than 65% of patients having chronic kidney disease and anaemia. After adjustment for all baseline differences, SGLT2i users experienced a greater increase in haemoglobin and haematocrit compared to SGLT2i non-users: haemoglobin +0.57 g/dl (95% confidence interval [CI] 0.04-1.10, p = 0.036) and haematocrit +1.64% (95% CI 0.18-3.11, p = 0.029). No significant differences were noted for iron biomarkers or any of the secondary outcomes. CONCLUSION Combined treatment with IV iron and background SGLT2i was associated with a greater increase in haemoglobin and haematocrit than IV iron without background SGLT2i. These results suggest that in HFrEF patients treated with IV iron, SGLT2i may increase the erythropoietic response. Further studies are needed to ascertain the potential benefit or harm of combining these two treatments in heart failure patients.
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Affiliation(s)
- Pedro Marques
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Paula Matias
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Milton Packer
- Baylor Heart and Vascular Institute, Dallas, TX, USA
- Imperial College, London, UK
| | - Joana T Vieira
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Abhinav Sharma
- Division of Cardiology, DREAM-CV Lab, McGill University Health Centre, Montreal, QC, Canada
| | - Thomas A Mavrakanas
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Fernando Friões
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Pedro Ferreira
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
- Inserm, Centre d'Investigations Cliniques, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
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