Searching in the maze: sodium–glucose cotransporter-2 inhibitors in kidney transplant recipients to improve survival

Abstract

Sodium-glucose-transporter-2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in chronic kidney disease (CKD) patients with and without diabetes. Kidney transplant recipients have been excluded from landmark trials using SGLT2i, and literature on safety and efficacy are scarce. Recent studies suggest that the SGLT2i use in kidney transplants with diabetes is safe, paving the way to investigate whether SGLT2i could also be able to reduce cardiovascular events and kidney function deterioration in kidney allograft recipients.

Sodium-glucose cotransporter 2 inhibitors and cardiorenal outcomes in kidney transplantation

“…A meta-analysis of studies involving around 132 KTRs reported a reduction in mean HbA1c by around 0.57% at the end of the follow-up period (95% CI: –0.97, –0.16; P = 0.006) [47]. However, a decrease in kidney function can pose a challenge in controlling blood glucose given the role of kidneys in the anti-hyperglycemic effect of SGLT2i [53 ▪▪ ]. In the studies that we included in our review, HbA1c reduction showed a wide range, which could be attributed to duration of the study, concomitantly administered medications and the severity of post-transplant DM [53 ▪▪ ].…”

“…However, a decrease in kidney function can pose a challenge in controlling blood glucose given the role of kidneys in the anti-hyperglycemic effect of SGLT2i [53 ▪▪ ]. In the studies that we included in our review, HbA1c reduction showed a wide range, which could be attributed to duration of the study, concomitantly administered medications and the severity of post-transplant DM [53 ▪▪ ]. In general, the studies where participants had higher baseline HbA1c and were followed for a longer time duration showed better improvements in HbA1c [32,51].…”