# Dapagliflozin-Induced Erythrocytosis in Chronic Kidney Disease: A Rare Occurrence

## TL;DR

This paper reports two cases of dapagliflozin-induced erythrocytosis in diabetic patients with chronic kidney disease, emphasizing the need for monitoring and early intervention.

## Contribution

The novelty lies in highlighting erythrocytosis as a rare but important adverse effect of dapagliflozin in CKD patients, a population where it is underrecognized.

## Key findings

- Two cases of dapagliflozin-induced erythrocytosis were observed in diabetic patients with CKD.
- Discontinuation of dapagliflozin led to a significant reduction in hemoglobin levels.
- Erythrocytosis onset was rapid and possibly exacerbated by CKD.

## Abstract

Erythrocytosis, a rare adverse effect associated with sodium-glucose cotransporter 2 inhibitors (SGLT2i), has been reported in diabetic patients, but its occurrence in those with chronic kidney disease (CKD) remains underrecognized. Here, we present two cases of dapagliflozin-related erythrocytosis in diabetic patients with CKD, highlighting the need for increased awareness among clinicians. Despite the established efficacy of SGLT2i in managing type 2 diabetes mellitus (T2DM) and its cardiovascular benefits, erythrocytosis poses a potential complication, necessitating thorough understanding and monitoring. While the precise mechanism of SGLT2i-induced erythrocytosis remains unclear, hypotheses include hemoconcentration and modulation of iron metabolism. Notably, our cases demonstrate a rapid onset of erythrocytosis, possibly exacerbated by CKD, emphasizing the importance of vigilant hemoglobin monitoring, especially in CKD patients on SGLT2i therapy. Timely discontinuation of dapagliflozin resulted in a significant reduction in hemoglobin levels, underscoring the critical role of early intervention in preventing erythrocytosis-related complications. This report advocates for routine hematological evaluation in CKD patients treated with SGLT2i to promptly detect and manage erythrocytosis, enhancing patient safety and improving clinical outcomes.