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Sodium-Glucose Cotransporter-2 Inhibitor in Diabetic and Nondiabetic Renal Transplant Recipients

Lucie Maigret1, Lucile Basle2, Valérie Chatelet3

  • 1Service de Néphrologie-Hypertension artérielle, Dialyses, Transplantation rénale, CHRU de Tours, Tours, France.

Kidney International Reports
|April 14, 2025
PubMed
Abstract

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) show promise in kidney transplant recipients (KTRs), with low adverse events and beneficial effects on proteinuria and blood pressure. Discontinuation was more frequent in those with lower kidney function.

Area of Science:

  • Nephrology
  • Pharmacology
  • Transplantation Medicine

Background:

  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are established treatments for cardiovascular disease and chronic kidney disease (CKD).
  • Their use in kidney transplant recipients (KTRs) is not well-studied, but marketing authorization allows for consideration.
  • Understanding SGLT2i safety and efficacy in KTRs is crucial for clinical practice.

Purpose of the Study:

  • To evaluate the real-world safety and efficacy of SGLT2 inhibitors in kidney transplant recipients.
  • To assess the incidence of adverse events and reasons for discontinuation in KTRs treated with SGLT2i.
  • To investigate the effects of SGLT2i on proteinuria and blood pressure in KTRs.

Main Methods:

  • Prospective, multicenter, real-life study of consecutive kidney transplant recipients (KTRs) treated with SGLT2i.
  • Data collected on patient demographics, comorbidities, concomitant medications, and treatment outcomes.
  • Analysis of adverse events, reasons for discontinuation, proteinuria levels, and blood pressure.

Main Results:

  • 347 KTRs treated with SGLT2i (97% dapagliflozin); 65.1% were diabetic, 70.6% on ACE inhibitors/ARBs.
  • Low incidence of urinary tract infections (6.6%) and genital mycosis (0.6%); no serious adverse events reported.
  • Discontinuation rate was 15.6%, primarily due to graft dysfunction (32%), infections (17%), and digestive symptoms (9%). Higher discontinuation in KTRs with eGFR < 30 ml/min/1.73 m².
  • SGLT2i reduced proteinuria in both diabetic and non-diabetic KTRs.
  • Antihypertensive effect observed in patients with uncontrolled hypertension.

Conclusions:

  • SGLT2i are used in KTRs in France, with infrequent and non-life-threatening side effects.
  • Discontinuation is more common in KTRs with impaired graft function.
  • Short-term antiproteinuric and antihypertensive effects are promising for KTRs.
Keywords:
proteinuriarenal transplantationsodium-glucose cotransporters-2 inhibitors

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