Efficacy and Safety of Sglt-2 Inhibitors In Renal Allograft Recipients: an Open-Label, Single-Center Prospective...

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Kidney transplant recipients (KTRs) face significant risks of cardiovascular and renal complications.
• Post-transplant diabetes mellitus (PTDM) is a common complication in KTRs, further increasing morbidity and mortality.
• Evaluating the efficacy of novel therapies like sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in this population is crucial.

Purpose of the Study:

• To assess the safety and effectiveness of SGLT-2i therapy in KTRs.
• To compare outcomes in KTRs with and without PTDM receiving SGLT-2i.
• To evaluate the impact of SGLT-2i on cardiovascular, renal, and overall mortality.

Main Methods:

• A prospective, single-center study included 2146 KTRs transplanted over one year prior with stable graft function.
• 107 KTRs were prescribed SGLT-2i (empagliflozin or dapagliflozin).
• Pseudo-randomization created an experimental group (n=78) with SGLT-2i and a control group (n=78) without SGLT-2i, with comparable baseline characteristics.

Main Results:

• SGLT-2i therapy was associated with a 60% reduction in all-cause mortality (RR 0.40; p=0.04).
• Adverse coronary and renal outcomes were significantly reduced by 75% (RR 0.25; p=0.03) and 72% (RR 0.28; p=0.02), respectively.
• The GFR decline was slower in the SGLT-2i group (-1.29 ml/min/1.73 m2/year vs. -3.33 ml/min/1.73 m2/year; p=0.047).

Conclusions:

• SGLT-2i therapy is safe and effective in reducing cardiovascular and renal mortality in KTRs.
• SGLT-2i therapy mitigates the risk of adverse cardiovascular and renal events.
• The benefits of SGLT-2i in KTRs, including slowing CKD progression, are independent of PTDM status.