Overview
In non-transplant patients with chronic kidney disease (CKD) and diabetes, the use of sodium glucose linked transporter inhibitors (SGLT-2i) has ben shown to reduce cardiovascular mortality, delay CKD progresion, and decrease proteinuria. The early safety outcomes of SGLT-2i has ben 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 Congres, C.
Key Information
Song and coleagues 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 creatine 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 enrolment criteria. Of those, 91% (n=12) received empagliflozin, 2% (n=2) received canagliflozin, and 7% (n=9) received dapagliflozin.
Summary
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=.01) over 12 months.