Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2is) in Kidney Transplant Recipients

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: SGLT2is have the potential to improve kidney function in kidney transplant recipients (KTRs) by reducing proteinuria and preserving eGFR, but safety concerns exist due to increased risk of urinary tract infections (UTI), volume depletion and genital infections in immunocompromised patients. We present a single center retrospective study assessing the safety of SGLT2i in KTRs. Methods: Data from 130 KTRs who were started on SGLT2i following KT were retrospectively collected from a single academic center. Data at drug initiation, and 12 months were assessed. T-test was performed to assess statistical significance in difference in clinical characteristics of KTRs at baseline and at 1 year post SGLT2i initiation. Results: Baseline characteristics are summarized in Table 1. Empagliflozin was the most prescribed SGLT2i and median time from transplant to drug initiation was 731 days. 45% of patients had diabetes pre-transplant, 37% had new onset diabetes post-transplant, and 18% were non-diabetics. Mean baseline estimated eGFR was 55.2 mL/min/1.73 m2. Mean HgbA1c at initiation was 6.9%, and urine albumin creatinine ratio (UACR) was 262 mg/g. 26% of patients had glycosuria at baseline. At 12 months, 88% patients developed glycosuria, 13 (10 %) had UTIs, and but only 16 (12.3%) patients had discontinued the needed to discontinue the SGLT2i. The reasons for drug discontinuation were recurrent UTIs (7), AKI acute kidney injury (3), lack of continued insurance coverage (3), nausea (1), foot infection (1) and new onset neurologic disease with urinary retention (1). When comparing mean eGFR, HbA1C and UACR at baseline and 12 months, no statistically significant difference was noted. The mean eGFR, however, was maintained at 12 months at 53.1 mL/min/1.73 m2. UACR at 6 months was 216 mg/g. Mean BMI improved at 12 months as compared to baseline (29.6 vs 31.6, p=0.03). A statistically significant improvement in mean magnesium levels was also observed (1.8 vs 1.7 mg/dl, p=0.001) Conclusions: SGLT2is appear to be safe for use in KTRs with low risk of UTI, AKI, or foot infections, and overall low incidence of drug discontinuation. Further studies are needed to study long-term impact of SGLT2i on allograft and patient survival. [Formula presented] [Formula presented] CITATION INFORMATION: Kreitler K., Fitzmaurice M., Wright S., Khoury N., Shrivastava P., Patel A., Prashar R. Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2is) in Kidney Transplant Recipients AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES:

Volume

25

Issue

8

First Page

S413

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