Dapagliflozin improves hemoglobin and anemia in chronic kidney disease: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: p = 0.02

• Effect Size: Mean difference 4.37 g/L for hemoglobin

• Primary Outcome: Hemoglobin increase of 4.37 g/L (95% CI: 0.71-8.03)

• Nnt Or Sensitivity: Hematocrit sensitivity analysis: MD = 2.15% (95% CI: 1.86-2.44, p < 0.00001)

• Confidence Interval: 95% CI: 0.71-8.03

Clinical Application

Dapagliflozin readily available but requires monitoring for ketoacidosis and volume depletion in CKD patients PBS-subsidised for diabetes and heart failure; TGA-approved but not specifically for CKD anemia; would require off-label use pending dedicated trials CKD patients with anemia, particularly those already on SGLT2 inhibitors for diabetes or cardiovascular protection

Abstract

Anemia becomes increasingly prevalent as kidney function declines. Current treatments carry multiple safety risks. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), dapagliflozin, have emerged as background anemia modulator, a promising alternative, showing protective effects against anemia. This study synthesizes evidence on dapagliflozin's potential to improve anemia in chronic kidney disease (CKD) patients. A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, including eight studies identified from six databases. Risk of bias was assessed using tools appropriate for each study design (RoB 2, NOS, JBI). Data were pooled using a random-effects model with RevMan 5.4. The primary analysis for hemoglobin demonstrated significant increase (MD = 4.37; 95% CI = 0.71-8.03; p = 0.02) and remained significant in the sensitivity analysis (MD = 4.11; 95% CI = 0.19-8.04; p = 0.04). A sensitivity analysis for hematocrit revealed a highly significant increase (MD = 2.15; 95% CI = 1.86-2.44; p < 0.00001). In the sensitivity analysis for adverse events dapagliflozin significantly reduced the overall risk (RR = 0.77; 95% CI = 0.59-0.99; p = 0.04). This finding was associated with significantly lower mortality (RR = 0.67; p = 0.02), while no significant differences were observed for cardiovascular (p = 0.22) or genitourinary events (p = 0.70). Dapagliflozin is associated with clinically meaningful improvements in hemoglobin and anemia outcomes in CKD. These findings suggest a potential erythropoietic benefit beyond glycemic control, although dedicated anemia-focused trials are needed to confirm clinical applicability.

References

1. 1.Irvania, Naufal, A., Tsauri, Ats, G. A., Yantisetiasti, Anglita, & Sofiatin, Y. (2026). Dapagliflozin improves hemoglobin and anemia in chronic kidney disease: a systematic review and meta-analysis. Renal Failure, 48(1). https://doi.org/10.1080/0886022X.2026.2636407