SGLT-2i therapy in kidney transplant recipients with diabetes

In non-transplant patients with chronic kidney disease (CKD) and diabetes, the use of glucose-linked transporter (SGLT-2i) inhibitors has been shown to reduce cardiovascular mortality, delay the progression of CKD, and decrease proteinuria. The first safety results of the SGLT-2i were validated in published data. However, there are few data available on long-term benefits among kidney transplant recipients.

In an oral presentation at the 2022 American Transplant Congress, C. Song and colleagues reported the results of a 12-month trial with SGLT-2i at one center in Virginia. The presentation was titled Intermediate outcomes of SGLT2 inhibitors among diabetic kidney transplant recipients🇧🇷

The single-center retrospective study included adult kidney transplant recipients at the center who met SGLT-2i initiation criteria. Eligible patients had type 2 diabetes, no acute kidney injury ≤ 30 days prior to initiation of SGLT-2i therapy, and estimated glomerular filtration rate (eGFR) > 25 mL/min/1.73 mtwo🇧🇷

The primary outcomes of interest were changes in urine protein creatinine ratio (UPCR), weight, hemoglobin A1c (HbA1c), and eGFR. Secondary outcomes were rates of urinary tract infections (UTIs) treated, diabetic ketoacidosis, amputations, and episodes of dehydration. Insurance preference dictated the choice of the specific SGLT-2i agent.

A total of 123 patients met the enrollment criteria. Of these, 91% (n=112) received empagliflozin, 2% (n=2) received canagliflozin, and 7% (n=9) received dapagliflozin. The median time from transplantation to initiation of SGLT-2i therapy was 250 days. The mean increase in eGFR from initiation of SGLT-2i therapy to 6 months was 2.95 mL/min/1.73 mtwo (95%CI, 0.19-5.72; P=.04); at 12 months, the mean increase was 4.09 mL/min/1.73 mtwo (95% CI, 0.60-7.57; P= 0.02).

There were significant improvements in UPCR (mean decrease of –0.53 mg/mg (95% CI, –0.02 to –1.04; P=0.021) and weight (mean decrease of –1.35 kg (95% CI, –0.75 to –1.96; P=.001) over 12 months. The average change in HbA1c was 0.05, without statistical significance.

One patient had euglycemic DKA, 15% (n=18) had UTI, 6% (n=7) had mild episodes of dehydration, and no patient required amputation.

In conclusion, the authors said, “In this follow-up report, we found that patients treated with SGLT-2i showed statistically significant improvement in eGFR at 6 and 12 months, along with reductions in UPCR. These 12-month trends point to improvements in kidney function and metabolic profiles. The risk of adverse events with SGLT2 inhibitor initiation after kidney transplantation was comparable to previously published data.”

Source: Song C, Brown A, Winstead R, et al. Intermediate outcomes of SGLT2 inhibitors among diabetic kidney transplant recipients. Abstract of a presentation at the 2022 American Transplant Congress (Abstract 30), Boston, Massachusetts, June 5, 2022.

SGLT-2i therapy in kidney transplant recipients with diabetes

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