{"id":"3690b2d6db25","type":"article","url":"https://hartvaat.nl/2026/10/24/sglt2-remmers-verhogen-hemoglobine-en-hematocriet-jama-metaanalyse/","title":"SGLT2-remmers verhogen hemoglobine en hematocriet — JAMA-metaanalyse","title_en":"Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2026.19921","source_url":"https://doi.org/10.1001/jama.2026.19921","authors":["Yaqin Yang","Changyuan Yang","Yanmei Wang","Pien Rawee","Aleix Cases","David E Leaf","Lucia Del Vecchio","Taulant Muka","Hiddo J L Heerspink","Ron T Gansevoort","Michele F Eisenga"],"significance":6,"published":"2026-11-02","source_date":"2026-10-24","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"A meta-analysis of 85 randomized trials (70,543 participants) demonstrates that SGLT2 inhibitors produce a small but statistically significant increase in hemoglobin (+0.60 g/dl) and hematocrit (+2.36%) compared with placebo. Secondary analyses also reveal elevated erythropoietin levels and reduced transferrin saturation, suggesting a modulatory effect on erythropoiesis and iron metabolism. While the clinical implications remain uncertain, these findings help clinicians interpret expected laboratory shifts in patients with heart failure, chronic kidney disease, or diabetes.","created":"2026-10-26T02:38:15Z","updated":"2026-10-26T02:38:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een meta-analyse van 85 RCT’s (70.543 patiënten) toont aan dat SGLT2-remmers leiden tot een kleine maar significante stijging van hemoglobine (+0,60 g/dl) en hematocriet (+2,36%) vergeleken met placebo. Daarnaast werden verhoogde erytropoëtinespiegels en een daling van de transferrineverzadiging waargenomen, wat wijst op een invloed op de erytropoëse en het ijzermetabolisme. Hoewel de klinische relevantie voor de dagelijkse praktijk onzeker blijft, helpt dit inzicht bij het interpreteren van laboratoriumveranderingen bij patiënten met hartfalen, CKD of diabetes.","abstract_original":"IMPORTANCE: In randomized clinical trials, sodium-glucose cotransporter 2 (SGLT2) inhibitor use was associated with increased hemoglobin and hematocrit compared with placebo. However, the magnitude and importance of this association remain unclear. OBJECTIVE: To evaluate the associations between SGLT2 inhibitor use and levels of hemoglobin, hematocrit, and markers of iron metabolism and erythropoiesis compared with placebo or active comparator. DATA SOURCES: PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to July 22, 2026. STUDY SELECTION: Randomized, double-masked clinical trials comparing SGLT2 inhibitor use with placebo or active comparators in patients with 1 or more of the following conditions: cardiovascular disease, diabetes, heart failure, and chronic kidney disease. DATA EXTRACTION AND SYNTHESIS: Three reviewers independently extracted data and results were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: Primary outcomes were changes in hemoglobin and hematocrit. Secondary outcomes were changes in red blood cell concentration, erythropoietin (EPO), and iron measures (serum iron, ferritin, transferrin saturation, and hepcidin). RESULTS: A total of 85 randomized clinical trials were analyzed (median [IQR] duration, 24 [12-32] weeks), including 70 543 participants (mean [SD] age, 62.4 [9.4] years; 25 334 female [35.9%]). Mean (SD) baseline hemoglobin was 13.6 (1.5) g/dL; baseline hematocrit was 41.5% (4.9). Seventy-eight clinical trials (67 208 participants) compared SGLT2 inhibitors with placebo, and 7 clinical trials (3335 participants) used active comparators, most commonly sitagliptin (2 trials [1158 participants]). From baseline to follow-up, hemoglobin changed by 0.55 g/dL (95% CI, 0.49 to 0.61 g/dL; P < .001) in the SGLT2 inhibitor group, and -0.08 g/dL (95% CI, -0.13 to -0.03 g/dL; P = .003) in the control group (difference, 0.60 g/dL; 95% CI, 0.55 to 0.66 g/dL; P < .001). From baseline to follow-up, hematocrit changed by 2.17% (95% CI, 1.95% to 2.39%; P < .001) in the SGLT2 inhibitor group and -0.13% (95% CI, -0.28% to 0.01%; P = .07) in the control group (difference, 2.36%; 95% CI, 2.19% to 2.52%; P < .001). Of the 6 secondary outcomes, 4 showed significant associations with SGLT2 inhibitors, including increased EPO (2.35 mIU/mL in SGLT2 inhibitor group vs 0.04 mIU/mL in control group; difference, 2.11 mIU/mL [95% CI, 0.5-3.71 mIU/mL]; P = .01) and decreased transferrin saturation (-2.2% in SGLT2 inhibitor group vs -0.10% in control group; difference, -0.84% [95% CI, -1.21% to -0.47%]; P < .001). CONCLUSIONS AND RELEVANCE: In a meta-analysis of randomized clinical trials, compared with control, SGLT2 inhibitor use was associated with small statistically significant increases in hemoglobin and hematocrit levels. The clinical significance of these findings is unclear."}