Sodium Glucose Cotransporter2 Inhibitors in Kidney Transplant Recipients

ABSTRACT

Background: Sodium glucose cotransporter2 inhibitors (SGLT2i) demonstrate a cardioprotective effect and are associated with slowing or preventing CKD progression in the native kidney. However, there is limited data in the literature about their use after a kidney transplantation. Method(s) This is an observational retrospective study in a cohort of kidney transplant recipients at Washington University in St. Louis, treated with SGLT2i for diabetes mellitus type 2. Data collection was conducted by chart review. Our primary endpoint was to assess the safety and adverse reactions in this cohort. Our secondary endpoints included assessments of change in weight/BMI, blood pressure, serum creatinine and eGFR, LDL, HDL and hemoglobin A1C every 6 months with a follow up to 2 years. Analysis for change of these parameters from baseline (at the time of start of the medication) was conducted using matched paired t test. Result(s) A total of 36 of kidney transplant recipients were included. The average age of patients was 55.5 +/- 10.4 years. 23 of 36 patients (63.9%) were males. The adverse events reported were congestive heart failure 2/36 (5.6%), AKI 2/36 (5.6%), candidiasis 1/36 (2.8%), and urinary tract infection 1/36 (2.8%). Our results also revealed that two patients died unrelated to medication use (1 patient died after COVID infection and 1 patient died due to septic shock from a foot infection). As shown in table 1 there was no significant change from baseline in weight/BMI, blood pressure, serum creatinine and eGFR, LDL, HDL or hemoglobin A1C at 6, 12, 18 and 24 months. Conclusion(s) Our preliminary data shows that SGLT2i are relatively safe in the kidney transplant population. Larger multicenter studies are needed to determine the efficacy of these drugs in improving renal function, decreasing cardiovascular events and survival post-transplant, as seen in non-transplant recipients.