Impact of Sglt-2 Inhibitors on Sickle Cell Disease Patients with Type 2 Diabetes: A Retrospective Matched Cohort Study
Abstract
Introduction: Sickle cell disease (SCD) is associated with an increased risk of chronic kidney disease (CKD), with 12% of patients developing CKD by a median age of 37 years in one large 40 year longitudinal study. Glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated reno-protective benefits in type 2 diabetes mellitus (T2DM) and CKD, but their efficacy in SCD nephropathy is not well studied. A retrospective analysis of 7 SCD patients with T2DM found observed treatment with GLP-1 agonists or SGLT-2 inhibitors improved estimated glomerular filtration rate (eGFR) slope, but increased the rate of vaso-occlusive pain episodes (VOEs). Additionally, a large placebo-controlled study showed that empagliflozin increased hemoglobin (Hgb) levels in patients with T2DM, but no SCD. In the previous study, serum erythropoietin (EPO) levels were found to be inappropriately normal or increased in all 27 patients with EPO tested, with a median of 10.3 mIU/mL (6.1-37.3 mIU/mL)
Methods: Using a large federated network database, we identified 75 patients with SCD and T2DM. Less than 20 patients had CKD. For our control group, we had 2,366 patients with SCD and T2DM, who were not on SGLT2 inhibitor therapy. There were 1,754 patients with CKD in this group. In this retrospective study, we matched 65 patient in SGLT2 cohort to 65 control group patients based on sex assigned at birth, age and co-morbidities including stage of CKD (if…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,366 participants or records.
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