SGLT-2i Therapy in Kidney Transplant Recipients With Diabetes

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

In an oral presentation at the 2022 American Transplant Congress, C. Song and colleagues reported on outcomes of a 12-month experience with SGLT-2i at a center in Virginia. The presentation was titled Intermediate Term Outcomes of SGLT2 Inhibitors Amongst 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 before initiation of SGLT-2i therapy, and estimated glomerular filtration rate (eGFR) >25 mL/min/1.73 m2.

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

A total of 123 patients met enrollment criteria. Of those, 91% (n=112) received empagliflozin, 2% (n=2) received canagliflozin, and 7% (n=9) received dapagliflozin. Median time from transplant to initiation of SGLT-2i therapy was 250 days. Mean increase in eGFR from initiation of SGLT-2i therapy to 6 months was 2.95 mL/min/1.73 m2 (95% CI, 0.19-5.72; P=.04); at 12 months, the mean increase was 4.09 mL/min/1.73 m2 (95% CI, 0.60-7.57; P=.02).

There were significant improvements in UPCR (mean decrease of –0.53 mg/mg (95% CI, –0.02 to –1.04; P=.021) and in weight (mean decrease of –1.35 kg (95% CI, –0.75 to –1.96; P=.001) over 12 months. The mean change in HbA1c was 0.05, which did not reach statistical significance.

One patient had euglycemic DKA, 15% (n=18) experienced UTIs, 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 had statistically significant improvement in eGFR at 6 and 12 months, along with reductions in UPCR. These 12-month trends point towards both improvements in renal function and metabolic profiles. The risk of adverse events with SGLT2 inhibitor initiation post-kidney transplant was comparable with previously published data.”

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