Campos-Ramírez N, Mariscal-Ramírez LA, Arellano-Martínez J

Language: Spanish
References: 15
Page: 78-85
PDF size: 805.95 Kb.

ABSTRACT

Introduction: glucose metabolism disorders are common among kidney transplant recipients. Between 10% and 40% of these patients develop post-transplant diabetes mellitus (PTDM). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are one of the beneficial pharmacological options for non-transplant diabetic patients, as their use has been shown to reduce proteinuria, slow the progression of kidney disease, and decrease cardiovascular mortality. However, evidence regarding their use in transplant recipients remains limited. Objective: to analyze the safety and reno-metabolic effects of the use of SGLT2i in patients with kidney transplants. Material and methods: a retrospective, longitudinal, comparative study was conducted. Kidney transplant recipients from June 2012 to May 2025 who were diagnosed with prediabetes, type 2 diabetes mellitus, or post-transplant diabetes mellitus and received SGLT2i therapy between September 2023 and January 2025 were included. Data was obtained from medical records. Baseline clinical and biochemical variables were recorded prior to drug initiation. Renal function and metabolic control parameters were assessed at 1 and 3 months after starting SGLT2i therapy. Statistical analyses were performed using SPSS v21, and a p-value < 0.05 was considered statistically significant. Results: we included nine patients with a mean age of 49 ± 8.2 years, most of whom were male (66.6%, n = 6). The predominant glycemic disorder was type 2 diabetes mellitus (55.5%, n = 5). At baseline, the mean serum creatinine was 1.1 ± 0.25 mg/dL, the mean estimated glomerular filtration rate (eGFR) was 74.68 ± 12.59 mL/min/1.73 m², and 66.6% (n = 6) presented proteinuria on urinalysis. The mean fasting serum glucose was 126.77 ± 26.78 mg/dL, and glycated hemoglobin (HbA1c) was 7.17 ± 1.36%. At the first month of follow-up, eGFR decreased to 71.59 ± 25.12 mL/min/1.73 m², while serum creatinine increased to 1.2 ± 0.30 mg/dL; both values showed a trend toward normalization by the third month. Blood glucose levels decreased by the third month, with a mean serum glucose of 113.9 ± 2.03 mg/dL and a mean HbA1c of 7.25 ± 1.41%. No adverse effects were reported. Conclusions: the use of SGLT2 inhibitors in kidney transplant recipients with impaired glucose metabolism demonstrated favorable numerical trends in short-term glycemic control and renal function; however, these results were not statistically significant. The therapy was well tolerated and appeared safe in this patient population. Further studies are required to confirm these findings and to clarify the potential medium- and long-term effects.

REFERENCES

1. Chowdhury TA. Post-transplant diabetes mellitus. Clin Med (Lond). 2019; 19 (5): 392-395. doi: 10.7861/clinmed.2019-0195.

2. Yudkin JS, Lehman R. Olmesartan, microalbuminuria, and type 2 diabetes. N Engl J Med. 2011; 364 (23): 2260; author reply 2262-3. doi: 10.1056/NEJMc1104826.

3. Wanner C, Heerspink HJL, Zinman B, Inzucchi SE, Koitka-Weber A, Mattheus M et al. Empagliflozin and kidney function decline in patients with type 2 diabetes: A slope analysis from the EMPA-REG OUTCOME trial. J Am Soc Nephrol. 2018; 29 (11): 2755-2769.

4. Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017; 377 (7): 644-657.

5. Halden TAS, Kvitne KE, Midtvedt K, Rajakumar L, Robertsen I, Brox J etal. Efficacy and safety of empagliflozin in renal transplant recipients with posttransplant diabetes mellitus. Diabetes Care. 2019; 42 (6): 1067-1074.

6. Zinman B, Wanner C, John M, Fitchett D, Bluhmki E, Hantel S, et al. Empaglifozin, cardiovascular outcomes and mortality in type 2 diabetes. N Engl J Med. 2015; 373: 2117-2128.

7. Lim JH, Kwon S, Jeon Y, Kim YH, Kwon H, Kim YS et al. The efficacy and safety of SGLT2 inhibitor in diabetic kidney transplant recipients. Transplantation. 2022; 106 (9): E404-E412.

8. AlKindi F, Al-Omary H, Hussain Q, Al Hakim M, Chaaban A, Boobes Y. Outcomes of SGLT2 inhibitors use in diabetic renal transplant patients. Transplant Proc. 2020; 52 (1): 175-178.

9. Song CC, Brown A, Winstead R, Yakubu I, Demehin M, Kumar D et al. Early initiation of sodium-glucose linked transporter inhibitors (SGLT-2i) and associated metabolic and electrolyte outcomes in diabetic kidney transplant recipients. Endocrinol Diabetes Metab. 2021; 4 (2): 2-4.

10. Fujita KK, Ye F, Collister D, Klarenbach S, Campbell DJT, Chew DS et al. Sodium-glucose co-transporter-2 inhibitors are associated with kidney benefits at all degrees of albuminuria: A retrospective cohort study of adults with diabetes. Diabetes Obes Metab. 2024; 26 (2): 699-709.

11. Salinas-Lezama E, Seniscal-Arredondo D, Alarcón-Sotelo A, Díaz-Greene EJ, Rodríguez-Weber FL. Efectos nefrológicos de los SGLT2. ¿Qué sabemos hasta ahora? Med Interna Méx. 2019; 35 (3): 379-388. Disponible en: https://doi.org/10.24245/mim.v35i3.2443

12. Kwon HY, Kong JM. Sodium/glucose cotransporter 2 (SGLT2) inhibitor for diabetic kidney transplant (KT) patients. Kidney Week 2017. New Orleans, LA, USA: American Society of Nephrology; 2017.

13. Mahling M, Schork A, Nadalin S, Fritsche A, Heyne N, Guthoff M. Sodium-glucose cotransporter 2 (SGLT2) inhibition in kidney transplant recipients with diabetes mellitus. Kidney Blood Press Res. 2019; 44 (5): 984-992. doi: 10.1159/000501854.

14. Ferreira JP, Zannad F, Butler J, Filippatos G, Pocock SJ, Brueckmann M et al. Association of empagliflozin treatment with albuminuria levels in patients with heart failure: a secondary analysis of EMPEROR-Pooled. JAMA Cardiol. 2022; 7 (11): 1148-1159. doi: 10.1001/jamacardio.2022.2924. Erratum in: JAMA Cardiol. 2022; 7 (11): 1177.

15. Rajasekeran H, Kim SJ, Cardella CJ, Schiff J, Cattral M, Cherney DZI et al. Use of canagliflozin in kidney transplant recipients for the treatment of type 2 diabetes: a case series. Diabetes Care. 2017; 40 (7): e75-e76.