Sodium-Glucose Cotransporter 2 Inhibitors in Diabetic Kidney Transplant Recipients: Impact on Glycemic Control, Graft Function, and Proteinuria

Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve albuminuria, the rate of chronic kidney disease (CKD) progression, and cardiovascular death in non-transplant patients with diabetes mellitus (DM) and proteinuria. However, kidney transplant recipients (KTRs) were excluded from the most extensive trials. This study aimed to evaluate graft function, proteinuria, and glycemic control in KTRs with pre- and post-transplant DM (PTDM) treated with SGLT2i. Methods: This is a single-center, retrospective, and observational study including transplant recipients older than 18 years old at transplantation, diagnosed with pre-transplant type 2 DM or PTDM, who were treated with SGLT2i after transplantation from June 2020 to June 2024. Results: Out of 1,883 KTRs followed at the center from June 2020 to June 2024, 31 patients received SGLT2i, 14 (45.2%) with pre-transplant DM, and 17 (54.8%) with PTDM. Fourteen (45.2%) completed the 24-month follow-up, including eight (57.1%) in the pre-transplant DM group and six (42.8%) in the PTDM group. In the pre-transplant DM group, fasting blood glucose (FBG) (134 92-295 mg/dL vs. 109 73-207, p = 0.24), estimated glomerular filtration rate (eGFR) (59.3 ± 19.2 vs. 68.1 ± 23.4, p = 0.35), and urinary protein-to-creatinine ratio (UPCR) (0.3 0.0-1.9 vs. 0.3 0.1-0.7, p = 0.80) remained stable. In the PTDM group, there was also no difference in the parameters analyzed, whether FBG (113 95-225 mg/dL vs. 108 92-149, p = 0.38), eGFR (73.1 ± 26.8 vs. 69.1 ± 28.9, p = 0.76), or UPCR (0.2 0.1-2.5 vs. 0.2 0.1-0.4, p = 0.21). Conclusion: These results suggest that the treatment has a beneficial effect on preserving graft function over a 2-year follow-up period. The treatment was well tolerated, with a low incidence of urinary tract infection or graft dysfunction.