#2323 Sodium-glucose cotransporter 2 inhibitors in kidney transplant recipients—effectiveness and safety

Abstract

Abstract Background and Aims Given the increasing incidence of posttransplant diabetes and the heightened cardiovascular burden among transplant recipients, the use of SGLT2 inhibitors (SGLT2i) in this population is attractive due to their cardiovascular and renoprotective advantages. However, evidence for diabetic kidney transplant recipients (DKTRs) is limited, primarily due to concerns regarding potential worsening of renal graft dysfunction and adverse effects. Method This retrospective study was conducted to evaluate the effectiveness and safety of SGLT2 inhibitors in kidney transplant recipients (KTRs). Individuals with type 1 diabetes (n = 2) and individuals submitted to a double kidney and pancreas transplant (n = 5) were excluded from the study to avoid diabetes type bias . The primary focus was on assessing SGLT2 inhibitors effect on parameters such as hemoglobin A1c levels, body mass index (BMI), lipid panel, hemoglobin levels, renal allograft function (estimated glomerular filtration rate), and urinary protein-to-creatinine ratio. Demographic, clinical, and laboratory data were collected and subjected to analysis using descriptive statistics with SPSS Statistics software. The data were presented as means ± standard error, and comparisons were conducted using the paired sample t-test. A significance level below 0.05 (P < 0.05) was considered statistically relevant. Results A total of 104 renal transplant patients were included. The study spanned a median observation period of 14 (2.0–71.0) months. Mean HbA1c decreased from 7.3 to 6.9% (P = 0.001). A significant improvement in BMI (27.6 to 27.0 kg/m2; P = 0.008), total and LDL-Cholesterol(P < 0.001 and P = 0.004, respectively) were also observed. Mean haemoglobin rate at baseline was 13.3 g/dL and also improved at end of follow-up to 13.5 g/dL (P = 0.065). Mean estimated glomerular filtration rate at baseline was 60.1 (26–120) mL/min/1.73 m2 and decreased to 54.8 throughout the follow-up (P = 0.007), while mean serum cystatin increased from 1.7 to 2.0 mg/L (P < 0.001). Regarding urinary protein:creatinine ratio, levels slightly but not significantly rose [+0.33 g/g]. Urinary tract infections occurred in 10% of the recipients. No other side effects were observed during the treatment course or neither the patients needed to discontinue the medication. Conclusion This study establishes that the use of SGLT2 inhibitors is both feasible and well-tolerated in kidney transplant recipients (KTRs), with no significant observed side effects. Further studies are required to clarify the impact of SGLT2 inhibitors on long-term patient and allograft survival.