Use of SGLT2 Inhibitors in Kidney Transplant Recipients

In patients with chronic kidney disease (CKD), use of sodium glucose cotransporter-2 (SGLT2) inhibitors has been associated with improved renal and cardiovascular outcomes. However, there is concern regarding use of SGLT2 inhibitors due to the risk of acute kidney injury (AKI) and urogenital infections.

During a poster session at the American Transplant Congress 2023, L. Liriano-Ward and colleagues at the Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, New York, reported on outcomes of kidney transplant recipients treated with SGLT2 inhibitors. The poster was titled A Single Center Experience With SGLT-2 Inhibitors Treatment in Renal Transplant Recipients.

The retrospective review included data on 85 of the 142 adult renal transplant patients who received treatment with an SGLT2 inhibitor. Exclusion criteria were combined organ transplant, missing data, or less than 1 month follow-up since initiation of treatment. Median age of the cohort was 65 years, 64.7% were male, 28.2% were Black, and 55.3% were Hispanic. The etiology of end-stage renal disease was diabetes in 56.5% of the cohort, hypertension in 24.7%, and glomerulonephritis in 9.4%. Sixty-seven percent received a deceased donor transplant and median dialysis vintage was 26 months.

Ninety-four percent of the patients had diabetes and treatment with an SGLT2 inhibitor was initiated at a median 73 months posttransplant. Of the overall cohort,  51.8% were started on dapagliflozin at a median starting dose of 5 mg daily, 45.9% were started on empagliflozin at 10 mg daily, and 2.3% were started on canagliflozin at 50 mg daily. By the end of the study period, 15.3% of the patients had discontinued the medication.

Median follow-up was 7.3 months. At follow-up, allograft survival was 97.6% and patient survival was 94.1%. AKI occurred in 11.8% of the cohort, urinary tract infection in 15.3%, hypoglycemia in 10.6%, and hypotension in 9.4%. None of the patients developed acute rejection.

Compared with prior to treatment, serum creatinine was higher at last follow-up (1.45 mg/dL vs 1.28 mg/dL; P=.04). There was no significant decrease in spot urine protein to creatinine ratio (822.6 mg/g vs 685.8 mg/g; P=.05). Following treatment, patients’ metabolic profile was significantly improved: body mass index was lower (26.9 kg/m² vs 28.5 kg/m² before treatment; P=.04), systolic blood pressure was lower (131 mm Hg vs 139 mm Hg; P=.02), and hemoglobin A1c was lower (7.7 vs 8.4; P=.01), Magnesium levels also improved following treatment (1.8 vs 1.7; P=.006).

In conclusion, the authors said, “Renal transplant patients treated with SGLT2 inhibitors had improved metabolic profile and no major adverse events. The incidence of AKI and urinary tract infection is comparable to published data in the transplant population. Larger studies are required to evaluate clinical outcomes in this patient population.”

Source: Liriano-Ward L, Azzi Y, Pynadath C, et al. A single center experience with SGLT2 inhibitor treatment in renal transplant recipients. C176. Abstract of a poster presented at the American Transplant Congress 2023; June 3-7, 2023; San Diego, California.