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Diabetes Mellitus in Kidney Transplant Recipients and New Hypoglycemic Agent Options

Giulia Bartoli1, Andrea Dello Strologo2,3, Maria Arena4

  • 1Nephrology and Dialysis Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy.

International Journal of Molecular Sciences
|July 12, 2025
PubMed

Insights

Newer diabetes medications, including SGLT2 inhibitors and GLP-1 RAs, show promise for kidney transplant recipients. These agents may improve outcomes by counteracting immunosuppression effects and reducing cardiovascular risks.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetes mellitus (DM) is common in kidney transplant recipients (KTRs), negatively impacting graft and patient survival.
  • Newer hypoglycemic agents, including SGLT2 inhibitors (SGLT2is), GLP-1 receptor agonists (GLP1RAs), and nonsteroidal mineralocorticoid receptor antagonists (ns-MRAs) like finerenone, are approved for chronic kidney disease (CKD) patients.
  • These drugs have demonstrated benefits in reducing cardiovascular (CV) events and kidney disease progression in diabetic CKD patients.

Purpose of the Study:

  • To review the use and potential benefits of SGLT2is, GLP1RAs, and ns-MRAs in KTRs with type 2 DM or post-transplant diabetes mellitus (PTDM).
  • To analyze literature data from observational studies, meta-analyses, and clinical trials regarding these agents in KTRs.

Main Methods:

  • Literature review of observational studies, meta-analyses, and clinical trials.
  • Analysis of drug mechanisms of action and their potential impact on KTRs.
  • Evaluation of safety and efficacy data, including interactions with immunosuppressive therapy and risk of rejection.

Main Results:

  • SGLT2is and GLP1RAs generally appear safe and effective in KTRs.
  • No increased risk of rejection or adverse interactions with immunosuppressive drugs reported for SGLT2is and GLP1RAs.
  • Limited data exist for finerenone, with one ongoing clinical trial; no literature data are currently available.

Conclusions:

  • SGLT2is and GLP1RAs may mitigate negative metabolic effects of immunosuppression in KTRs, potentially reducing PTDM and CV events.
  • Despite 2022 KDIGO guideline caution, recent expert consensus encourages the use of these agents in KTRs.
  • Further research, particularly on finerenone, is needed, but current evidence supports the use of SGLT2is and GLP1RAs in this population.
Keywords:
chronic kidney diseaseglucagon-like peptide-1 receptor agonistshypoglycemic agentkidney transplantationnonsteroidal mineralocorticoid receptor antagonistpost-transplant diabetes mellitussodium glucose co-transporter type 2 inhibitors

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