Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have cardioprotective and renoprotective effects. However, experience with SGLT2i in diabetic kidney transplant recipients (DKT) is limited. Methods This observational multicentre study was designed to examine the efficacy and safety of SGLT2i in DKTR. The primary outcome was adverse effects within 6 months of SGLT2i treatment. Results Among 339 treated DKTR, adverse effects were recorded in 26%, the most frequent being urinary tract infection (UTI) (14%). In 10%, SGLT2i were suspended mostly because of UTI. Risk factors for developing UTI were a prior episode of UTI in the 6 months leading up to SGLT2i onset [OR 7.90 (CI 3.63–17.21)] and female sex [OR 2.46 (CI 1.19–5.03)]. In a post-hoc subgroup analysis, the incidence of UTI emerged as similar in diabetic kidney transplant recipients treated with SGLT2i for 12 months than non-diabetic kidney transplant recipients (17.9% vs 16.7%). Between baseline and 6-month, significant reductions were observed in body weight [─2.22 (─2.79, ─1.65) kg], blood pressure, fasting-glycemia, HbA1c [─0.36 (─0.51, ─0.21) %], serum uric acid [─0.44 (─0.60, ─0.28) mg/dl] and urinary protein/creatinine ratio, while serum magnesium [+0.15 (0.18, 0.11) mg/dl] and hemoglobin levels rose [+0.44 (0.28–0.58]. These outcomes persisted in participants followed over 12 months of treatment. Conclusions SGLT2i in KT offers benefits in terms of controlling glycemia, weight, blood pressure, anemia, proteinuria, and serum uric acid and magnesium. UTI was the most frequent adverse effect. According to our findings, these agents should be prescribed with caution in female DKTR and those with a history of UTI.

BACKGROUND AND AIMS SGLT2 inhibitors (SGLT2i) are the first-line therapy in patients with type 2 diabetes mellitus (DM2) and CKD, together with metformin according to most recent published guidelines. They are related to better renal and cardiovascular outcomes. SGLT2i could be potentially benefitial in terms of renal function preservation and cardiovascular outcomes in kidney transplantion (KT). Despite published data about SGLT2i in KT patients with DM2 or new-onset diabetes after transplantation are limited, their use seems to be common in everyday clinical practice. Our aim is to investigate if SGLT2i are safe and well tolerated in a cohort of KT recipients, as well as to analyze clinical and laboratory data at 6 months after SGLT2i initiation. METHOD Multicentre observational study in KT recipients with diabetes under SGLT2i treatment. RESULTS A total of 323 patients were included, and 284 completed a 6-month follow-up. Mean age was 61.2 ± 10.3 years old, 74.4% were men and 41% presented DM2. Previous antidiabetic therapies: insulin (48.1%), DPP4 inhibitors (36.1%) and metformin (33.1%). Empagliflozine was started in 55.8%, dapagliflozine in 23.2% and canagliflozin in 20.6%. After SGLT2i initiation, body weight reduction, an improvement in blood pressure and glycaemic control, higher haemoglobin levels and a decrease in cholesterol levels were observed. Also, a mild decrease in eGFR was detected while albuminuria was lower. These differences were statistically significant (Table 1). In 34 patients (10.5%), SGLT2i was stopped: 2.78% presented urinary tract infection (UTI), 1.5% balanitis and 1.2% important eGFR decreasing slope. During the study period, six patients presented a graft loss (one related to SLGT2) and six patients died (deaths not related to SGLT2i). CONCLUSION SGLT2i have a safe security profile in KT, and are related to a better glycaemic and blood pressure control, as well as to a decrease in albuminuria, and to an improvement in cardiovascular risk factors. Thus, SGLT2i should be prescribed in KT recipients with DM2 or NODAT with adequate eGFR. UTI surveillance is essential in these patients.