Sodium-Glucose Cotransporter 2 (SGLT2) Inhibition in Kidney Transplant Recipients with Diabetes Mellitus
Open accessAbstract
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibition has been shown to reduce cardiovascular mortality and preserve kidney function in patients with type 2 diabetes. Kidney transplant recipients with diabetes demonstrate increased risk and accelerated progression of micro- and macrovascular complications and may specifically benefit from SGLT2 inhibition. However, potential concerns of SGLT2 inhibition include volume depletion and urinary tract infections. Objectives: We report data on the use of SGLT2 inhibitors in a case series of ten patients with diabetes after kidney transplantation in order to analyze efficacy, safety, and the effect on renal function. Methods: Patients with a stable allograft function and no history of recurrent urinary tract infections were eligible. The SGLT2 inhibitor empagliflozin was given as add-on to preexisting antidiabetic treatment with initial dose reduction of the latter. Results: Median estimated glomerular filtration rate at baseline was 57 mL/min/1.73 m 2 and remained stable throughout the follow-up of 12.0 (5.3–12.0) months. Median HbA 1c decreased from 7.3 to 7.1%. The rate of urinary tract infections and other side effects was low. Conclusions: SGLT2 inhibition is feasible and well tolerated in selected kidney transplant recipients with diabetes. Whether SGLT2 inhibition is able to reduce cardiovascular mortality and improve allograft survival in these patients has to be addressed in further studies.
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For T2D and posttransplant diabetes, it is reasonable to treat kidney transplant recipients with metformin according to eGFR, as for the broader population with T2D, because risks of metformin are related to kidney function.
“For T2D and posttransplant diabetes, it is reasonable to treat kidney transplant recipients with metformin according to eGFR, as for the broader population with T2D, because risks of metformin are related to kidney function (80–84).”
From Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (2022) · cites this paper as [83]
Patient Characteristics (p. 3) reports that 20% of the kidney transplant recipients were already taking metformin, supporting its use in some recipients. But the paper does not recommend metformin treatment according to eGFR or say that metformin risks depend on kidney function; the eGFR eligibility threshold in Study Participants (p. 3) applies to SGLT2 inhibition, not metformin. (LLM, conf=0.78)
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- Authors
- Mahling, M., Schork, A., Nadalin, S., Fritsche, A., Heyne, N., & Guthoff, M.
- Affiliations
- German Center for Diabetes Research (DE)
- University of Tübingen (DE)
- Venue
- Kidney and Blood Pressure Research
- Publisher
- S. Karger AG
- Published
- 2019
- Volume
- 44
- Issue
- 5
- Pages
- 984-992
- ISSN
- 1420-4096 (ISSN-L)
- 1423-0143
- OpenAlex
- W2969999327
- Cited by
- 95
- References
- 23
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 18 · 2023: 13 · 2022: 12 · 2021: 22 · 2020: 6 · 2019: 1
- FWCI
- 8.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Kidney & Blood Pressure Research (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PuSH - Publication Server of Helmholtz Zentrum München (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Site cant be reached (submittedVersion, cc-by-nc-nd)
- Funders
- Deutsche Forschungsgemeinschaft
- Eberhard Karls Universität Tübingen
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- SGLT2 inhibition, empagliflozin, kidney transplantation, type 2 diabetes, renal function, estimated glomerular filtration rate, glycemic control, urinary tract infection, hypovolemia, allograft survival, cardiovascular mortality
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Humans, Middle Aged, Prospective Studies, Kidney Transplantation, Sodium-Glucose Transporter 2
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