Efficacy and Safety of Sodium Glucose Cotransporter 2 Inhibitor in Heart Transplant Recipients with Chronic Kidney Disease

Chronic kidney disease (CKD) is a major long-term complication following heart transplantation (HT). The safety and efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2i) for HT recipients with CKD remains unclear. We retrospectively reviewed the records of HT recipients who were followed up between April 2017 and December 2024 at our hospital; those with CKD who initiated SGLT2i at least 6 months after HT and had available follow-up data for 6 subsequent months were included. Among 91 patients who initiated SGLT2i, 45 were eligible (median age: 50 [47–59] years; 11 (24.4%) female). The median estimated glomerular filtration rate (eGFR) at SGLT2i initiation was 42.9 [33.8–50.6] mL/minute/1.73 m2. All patients continued SGLT2i without adverse events. Relative change in eGFR improved significantly from −9.1% in the 6 months before SGLT2i to +3.7% in the 6 months after (P = 0.043). Uric acid and hemoglobin levels improved (P < 0.001 and 0.002, respectively). Patients were stratified into 2 groups based on the relative change in eGFR to identify factors associated with improvement: those with a positive change (n = 23) and those without (n = 22). In logistic regression analysis adjusting for age and sex, lower eGFR (odds ratio: 1.09, 95% confidence interval: 1.02–1.15, P = 0.013) and non-ischemic etiology of heart failure (odds ratio: 18.9, 95% confidence interval: 1.66–215.0, P = 0.018) were associated with eGFR improvement after SGLT2i initiation. SGLT2i use appears safe and helps prevent CKD progression in HT recipients with CKD.