SGLT-2 Inhibition in Kidney Transplant Recipients With Diabetes

Previous studies have shown that the use of sodium glucose linked transporter inhibitors (SGLT-2i) in nontransplant patients with diabetes and chronic kidney disease (CKD) reduces cardiovascular mortality and delays progression of CKD. Additional published data have validated the early safety outcomes associated with SGLT-2 inhibition.

According to Chelsey Song, PharmD, and colleagues at the Virginia Commonwealth University, Richmond, Virginia, there are few data available on the long-term renal benefits of SGLT-2 inhibition among recipients of kidney transplantation and the impact on kidney function and metabolic outcomes.

During a poster session at the American Society of Nephrology Kidney Week 2022, the researchers reported results of 1 year of use of SGLT-2 inhibition at their center. The poster was titled One Year Outcome of SGLT2 Inhibitors Amongst Diabetic Kidney Transplant Recipients.

The single-center, retrospective study included adult kidney transplant recipients who met SGLT-2i initiation criteria. Patients were eligible for study inclusion if they had type 2 diabetes (preexsiting or new onset posttransplant), no acute kidney injury (AKI) <30 days prior to drug initiation, and an estimated glomerular filtration rate (eGFR) >25 mL/min/1.73 m2.

The primary outcomes of interest were changes in weight, hemoglobin A1c (HbA1c), and eGFR. Secondary outcomes were rates of treated urinary tract infections (UTIs), diabetic ketoacidosis (DKA), and amputations. The choice of the specific SGLT-2i agent was based on insurance preference.

A total of 123 patients met enrollment criteria. Median time from transplant to initiation of SGLT-2i was 250 days. Mean change in eGFR from initiation to drug therapy to 6 and 12 months was 2.95 mL/min/1.73 m2 (P=.04) and 4.09 mL/min/1.73 m2 (P=.02), respectively. There were also significant improvements in weight over the course of 12 months. Mean change in HbA1c was 0.05.

Of the total cohort, 91% (n=112) were treated with empagliflozin, 2% (n=2) were treated with canagliflozin, and 7% (n=9) were treated with dapagliflozin. One patient had euglycemic DKA and 18 (15%) experienced UTI. None of the patients experienced amputations or hospitalizations due to drug-induced AKI.

In conclusion, the researchers said, “Amongst diabetic kidney transplant patients, we found that patients who were treated with SCLT-2i had statistically significant improvement in eGFR at 6 and 12 months. The risk of adverse events with SGLT-2i initiation post kidney transplant was comparable with previously published data and confer a trend towards both improvement in renal function and metabolic profile.”

Source: Song C, Brown A, Winstead R, Sterling S, Christensen JL, Yakubu I, Gupta G. One year outcomes of SGLT2 inhibitors amongst diabetic kidney transplant recipients. FR-PO811. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 4, 2022; Orlando, Florida.