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Updated: Sep 14, 2025
TBase - an Integrated Electronic Health Record and Research Database for Kidney Transplant Recipients
Published on: April 13, 2021
SGLT2 Inhibitors and GLP-1 Receptor Agonists in Kidney Transplantation: A Systematic Review and Meta-Analysis
Sul A Lee1,2, Rucháma Verhoeff2, Frank Hullekes2
1Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
Background:
Kidney transplant (KT) recipients experience high rates of cardiovascular disease, allograft dysfunction, and diabetes, negatively impacting long-term outcomes. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) provide cardiovascular and kidney benefits in non-KT recipients, but evidence in KT recipients remains limited. This systematic review and meta-analysis provide updated evidence on the efficacy and safety of SGLT2i and GLP-1RAs on KT recipients.
Methods:
A comprehensive search of MEDLINE, Embase, and Cochrane databases was conducted through February 27, 2025. Data extraction, risk of bias assessment, and meta-analysis were performed using standardized methods with a random-effects model.
Results:
A total of 32 studies, including 7834 KT recipients, were analyzed, comprising 21 studies (3856 patients) on SGLT2i and 12 studies (3978 patients) on GLP-1RAs. Their use was associated with reduced mortality and improved cardiovascular and kidney outcomes in matched control studies. Both agents promoted weight loss (SGLT2i: standardized mean difference -0.59; 95% confidence interval [CI], -1.04 to -0.15; GLP-1RA: standardized mean difference -0.27; 95% CI, -0.44 to -0.10) and hemoglobin A1c reduction (SGLT2i: mean difference, -0.33%; 95% CI, -0.55% to -0.12%; GLP-1RA: mean difference, -0.48%; 95% CI, -0.82% to -0.13%) while maintaining stable kidney function. SGLT2i increased serum magnesium levels and reduced uric acid levels. Safety analysis showed no increased risk of infections (SGLT2i) or pancreatitis (GLP-1RAs).
Conclusions:
SGLT2i and GLP-1RA were associated with improved survival, cardiovascular, and kidney outcomes with a favorable safety profile. Future randomized controlled trials are necessary to confirm the efficacy and safety in this high-risk population.
Insights
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve survival and cardiovascular and kidney outcomes in kidney transplant recipients. These medications demonstrate a favorable safety profile, warranting further investigation in this population.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Kidney transplant recipients face significant risks of cardiovascular disease, allograft dysfunction, and diabetes, impacting long-term survival.
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown cardiovascular and kidney benefits in non-transplant populations.
- Limited evidence exists regarding the efficacy and safety of SGLT2i and GLP-1RAs in kidney transplant recipients.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of SGLT2i and GLP-1RAs in kidney transplant recipients.
- To provide updated evidence on the impact of these agents on cardiovascular and kidney outcomes.
- To assess the safety profile of SGLT2i and GLP-1RAs in this specific patient group.
Main Methods:
- A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases up to February 27, 2025.
- Data extraction, risk of bias assessment, and meta-analysis were performed using standardized methods.
- A random-effects model was employed for the meta-analysis.
Main Results:
- Analysis of 32 studies involving 7834 kidney transplant recipients (21 on SGLT2i, 12 on GLP-1RAs) showed reduced mortality and improved cardiovascular and kidney outcomes.
- Both SGLT2i and GLP-1RAs promoted significant weight loss and reduced hemoglobin A1c levels, while maintaining stable kidney function.
- SGLT2i increased serum magnesium and reduced uric acid; no increased risk of infections (SGLT2i) or pancreatitis (GLP-1RAs) was observed.
Conclusions:
- SGLT2i and GLP-1RAs are associated with improved survival, cardiovascular, and kidney outcomes in kidney transplant recipients.
- These agents exhibit a favorable safety profile in this high-risk population.
- Further randomized controlled trials are essential to confirm these findings and guide clinical practice.
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