#2275 Beyond glucose control: SGLT2 inhibitors' impact on hematological parameters in lupus nephritis patients
Authors: Mohamed Nourelsabah , Refaie Ayman F , Zayed Karem N , Mortada Wael I , Nabieh Kareem A , Sobh Mohamed A 
Published: May 2024

Abstract

Background and Aims
There is a broad spectrum of hematologic manifestations in SLE including lymphopenia, anemia, thrombocytopenia, or pancytopenia. Anemia worsens the prognosis of many chronic diseases including lupus nephritis. A recent systematic review and metanalysis showed that hemoglobin and hematocrit levels were significantly increased with SGLT2i therapy when compared to placebo. This study aimed to investigate the effect of SGLT2 inhibitors on hematological parameters including iron profile, hepcidin and erythropoietin levels in lupus nephritis patients.

Method
Double blind randomized controlled trial. The material of the current study included 79 Lupus nephritis patients who were recruited from Nephrology clinic- Urology and Nephrology Center- Mansoura University. Patients with an estimated glomerular filtration rate (eGFR) &gt;30 ml/min/1.73 m2 had been randomly assigned to 2 groups Study group: included 38 lupus nephritis patients who were randomly assigned to receive dapagliflozin (10 mg once daily) Placebo group: included 41 lupus nephritis who were assigned to receive placebo. The two groups were randomly assigned using computer-generated random tables in a 1:1 ratio and followed up for 12 months. The findings were recorded, tabulated, and analyzed using SPSS22 for windows.

Results
Both groups had similar ages and gender distribution. BMI, diabetes mellitus, and hypertension rates were comparable between groups. The duration of lupus nephritis and management approaches did not differ. Biopsy results indicated no differences in the class of lupus nephritis. Serum chemistry, including serum creatinine, was similar between groups. The mean hemoglobin levels, MCV and MCH are similar between the control and study groups, with no statistically significant difference (p = 0.5, 0.9 and 0.9 respectively). Regarding iron indices, the median ferritin, TSAT levels show a numerical difference, but it does not reach statistical significance (p = 0.09, 0.05), The mean erythropoietin and hepcidin levels are not significantly different between the groups (p value= 0.1 and 0.9 respectively) also, platelet counts are similar between the groups (p = 0.7). compares hematological investigations before and after the intervention in the study group. There is a statistically significant increase in mean hemoglobin levels post-intervention compared to baseline (p = 0.02) and the mean MCH levels show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.1), but the mean MCV levels do not show a statistically significant change post-intervention (p = 0.7). The median ferritin levels and TSAT values show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.8 and 0.9 respectively). There is a statistically significant decrease in mean hepcidin levels post-intervention (116 ± 15 from baseline 181 ± 76) and (p = 0.001). erythropoietin levels show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.1). there is a slight decrease in platelets counts after intervention but make statistically significant (p = 0.01), but The hematological data after 12 months suggest overall similarity between the control and study groups in terms of hemoglobin, MCV, MCH, ferritin, TSAT, and platelet count, also hepcidin and erythropoietin levels were comparable between both groups (P = 0.7). percentage of participant with anemia (Hgb&lt; 12 g/dl) decreased in study group after intervention from 61% to 42% but with no significant difference with control group (p = 0.3)

Conclusion
Anemia in lupus nephritis patients is primarily due to iron deficiency, associated with elevated hepcidin levels. Further research is needed to explore these patients' underlying causes of anemia. SGLT2 inhibitors are important add on drugs that has positive effect on varies hematological parameters in lupus nephritis patients in addition to their renal benefits.