Effects of sodium glucose transporters 2-inhibitors on body mass index and systolic blood pressure in kidney transplant recipients with or without diabetes mellitus: a multicenter propensity score-matched analysis

Background: Sodium Glucose Transporters Inhibitors 2 (SGLT2i), have represented one of the most relevant revolutions in the field of nephrology in recent years, but strong evidence regarding their use in kidney transplant recipients (KTR) is still lacking. We therefore performed a multi-center retrospective analysis, in order to evaluate the impact of SGLT2i in KTR with and without diabetes. Methods: All consecutive adult KTR followed at the three participating outpatient Nephrology Clinics between 2015 and December 2023 who were prescribed an SGLT2i were identified and constituted the pool of treated subjects. KTR who were not prescribed SGLT2i during the same time frame served as the source population for the control group. After performing propensity score matching, patients on SGLT2i (n = 88) and matched controls (n = 88) were selected. Longitudinal changes in body mass index (BMI), blood pressure (BP) and kidney parameters were assessed. Results: The SGLT2i group showed a mean difference in BMI decrease of 0.81 and 1.17 kg/m² Kg/m2 at 6 months and 12 months respectively (P<0.02) compared to controls. Similarly, systolic blood pressure (SBP) was significantly lower in KTR on SGLT2i at 12 months (mean difference -5.83 mmHg, P=0.042). No changes over time were observed for the other analyzed variables, including eGFR and 24-h proteinuria. None of the patients developed genital infections or euglycemic ketoacidosis. Urinary tract infections were the most common side effect (12.4%) and did not occur significantly more frequently among SGLT2i users. Conclusion: SGLT2i have a favorable effect on SBP and BMI in KTR. Results concerning nephroprotection and safety are promising, but have to be confirmed in the long term.