*Purpose: The use of Sodium Glucose Linked Transporter Inhibitors (SGLT-2i) among non-transplant diabetic patients with chronic kidney disease (CKD) has demonstrated reduced cardiovascular mortality, delayed CKD progression, as well as decreased proteinuria. While published data has validated the early safety outcomes of SGLT-2i, there is a current lack of evidence on the long-term renal benefits amongst kidney transplant (KT) recipients, including impact on proteinuria, kidney function, and metabolic outcomes. We aimed to bridge this knowledge gap and report our 12-month experience of SGLT-2i at our center.

*Methods: This was a single center, retrospective study, conducted in adult KT recipients who met SGLT-2i initiation criteria at our center. Patients were eligible if they had type II diabetes; no AKI ≤30 days prior to drug initiation; and an estimated glomerular filtration rate (eGFR) >25 mL/min. Primary outcomes were changes in urine protein creatine ratio (UPCR), weight, hemoglobin A1C (HgA1c), and eGFR. Secondary outcomes included rates of treated urinary tract infections (UTI), diabetic ketoacidosis (DKA), amputations, and dehydration episodes. Choice of the specific SGLT-2i agent was based upon insurance preference

*Results: Of the 123 patients that met criteria for enrollment, 112 (91%) received empagliflozin, 2 (2%) received canagliflozin, and 9 (7%) received dapagliflozin. Median time from transplant to SGLT-2i initiation was 250 days (IQR 88-887). The mean increase in eGFR from initiation to 6 and 12 months of therapy was 2.95 mL/min [(SD:14.8, p=0.04(CI:0.19,5.72))] and 4.09 mL/min [(SD:17.7, p=0.02 (CI: 0.60,7.57))], respectively. There were also significant improvements in UPCR with a mean decrease of -0.53 mg/mg [(SD:1.68, p=0.021 (CI:-0.02, -1.04))], and in weight with mean decrease of -1.35 kg [(SD 3.27, p=0.001 (CI:-0.75, -1.96))] over 12 months. Mean change in HgbA1c was 0.05 [(SD 1.72, p=0.759 (CI: -0.28, 0.39))]. Overall 1 patient had euglycemic DKA, 18 (15%) experienced UTIs, 7 (6%) experienced mild dehydration episodes, with no patients requiring an amputation

*Conclusions: 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 improvement in renal function and metabolic profiles. The risk of adverse events with SGLT2 inhibitor initiation post-kidney transplant was comparable with previously published data.

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