Use of SGLT2i in Non-Diabetic Kidney Transplant Recipients

The potential anti-proteinuric effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) is of special interest in kidney transplantation. Its benefits have been demonstrated in diabetic kidney transplant recipients (KTRs). We analyzed the efficacy and safety of SGLT2i in non-diabetic KTRs collecting clinical and analytical data at baseline and 6 months after the introduction of the drug.

We performed a unicenter observational study including all non-diabetic KTRs who were prescribed SGLT2i as antiproteinuric therapy. We analyzed clinical and analytical data at baseline and after 6 months of starting SGLT2i.

We included 22 patients (68.2% men), median age 58 years, with a median post-transplant period of 67 months. Hypertension was present in 95% of the patients, 90% had dyslipidemia, and 68.2% were receiving treatment with renin-angiotensin-aldosterone system blockade agents plus antialdosterone drugs. The most used SGLT2i was dapagliflozin (91%). The median baseline creatinine was 2.1 (1.48 to 2.85) mg/dL, estimated glomerular filtrate rate (eGFR) 31 (23.7 to 45,2) mL/min, and urinary protein/creatinine ratio 1.68 (0.58 to 2.9) g/g. After 6 months of follow-up, we found a significant reduction in proteinuria (1.68 to 1.06 g/g, P = .025), as well as a reduction in uric acid and high-density lipoprotein (HDL). There was a mild significant reduction in eGFR (31 to 28.5 mL/min, P = .001), which was greater in patients with recurrence of the underlying disease or chronic rejection. The drug was discontinued in two patients (9.1%): one due to a urinary tract infection (UTI) and another one due to hemodialysis initiation. There were no cardiovascular events or death.

The use of SGLT2i in our cohort was effective to reduce proteinuria in non-diabetic KTRs after 6 months of treatment with an acceptable safety profile.