Sodium-Glucose Cotransporter 2 Inhibitors to Treat Diabetes Mellitus After Kidney Transplant
1Pharmacy, Mayo Clinic, Rochester, MN, 2Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, 3Health Sciences Research, Mayo Clinic, Rochester, MN, 4Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, 5Nephrology Transplant, Mayo Clinic, Phoenix, AZ, 6Nephrology, Mayo Clinic, Jacksonville, FL, 7Transplant, Mayo Clinic, Rochester, MN, 8Division of Transplant Surgery, Mayo Clinic, Rochester, MN
Meeting: 2022 American Transplant Congress
Abstract number: 757
Keywords: Hyperglycemia, Kidney transplantation, Metabolic complications, Post-transplant diabetes
Topic: Clinical Science » Kidney » 35 - Kidney: Cardiovascular and Metabolic Complications
Session Information
Session Name: Kidney: Cardiovascular and Metabolic Complications
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: This study describes experience prescribing sodium-glucose cotransport 2 inhibitors (SGLT2i) after kidney transplant to evaluate safety and effectiveness.
*Methods: This is a retrospective, institutional review board approved, study across three transplant centers within one health system identifying kidney transplant recipients (KTR) on a SGLT2i between April 2013 and Oct 2020. Extracted data included adverse effects, discontinuation, kidney function, HbA1c and diabetes treatment regimens. Three investigators evaluated adverse events to assess SGLT2i contributions.
*Results: We identified 39 KTR on SGLT2i, 27 on therapy for >12 months. Median time [IQR] from transplant to initiation was 28 [16-60] months. Most KTR used 3 antihyperglycemic agents, 27 (70%) including insulin. Ten (25%) adverse events occurred, 6 were urinary tract infections (UTI). Five KTRs with a UTI had a history of UTIs prior to starting a SGLT2i and four continued therapy without recurrence. One KTR was hospitalized for UTI and ketoacidosis. Seventeen (43%) discontinued the SGLT2i, 6 due to cost and 4 due to kidney function decline. Three of these 4 were on the SGLT2i for >12 months, the cause of eGFR decrease was independent of SGLT2i use in all 4 cases without adverse effects reported at discontinuation. For the cohort, kidney function was stable, see Figure 1. Median change in HbA1c from baseline was -0.6% [-1.2-0, p=0.013] at 3 months and -0.4% [-1.4-0.1, p=0.016] at 12 months. The number of antihyperglycemic agents, insulin requirements, and tacrolimus exposure was unchanged. Notable weight decrease of 1.6 kg [0-2.6, p=0.11] at 3 months for 15 KTR with weight data available.
*Conclusions: SGLT2i may be a safe diabetes treatment for KTR. Cost is a barrier to SGLT2i therapy and UTIs the most encountered adverse event. While a majority of those with a UTI continued therapy, caution in KTR with recurrent UTI is advised. Rise in SCr upon starting SGLT2i initiation is expected but was not significant at 3 or 12 months. More studies are needed to understand the safety profile and determine the effect of SGLT2i on diabetes-related comorbidities among KTR.
To cite this abstract in AMA style:
Brokmeier HM, Leung SB, Kukla A, Mara KC, Shah P, Kudva Y, Mour GK, Wadei HM, Hill JM, Stegall MD, Lemke A. Sodium-Glucose Cotransporter 2 Inhibitors to Treat Diabetes Mellitus After Kidney Transplant [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/sodium-glucose-cotransporter-2-inhibitors-to-treat-diabetes-mellitus-after-kidney-transplant/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress