FLOZINATION IN KIDNEY TRANSPLANT RECIPIENTS: IS IT SAFE?

Introduction:

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been established as antiproteinuric and nephroprotective agents in diabetic as well as non diabetic proteinuric diseases of the kidney. Despite the evidence for both renoprotective and cardioprotective effects, their use in the post kidney transplant setting is limited. There is a dearth of studies on the safety of their use in this population group. This is a retrospective study on the safety and efficacy of SGLT2i in the post renal transplant patients. 

Methods:

Electronic medical records were used to extract details of renal transplant recipients who had been started on SGLT2i for any indication. Data were collected regarding baseline demographic details, transplant details, indication for starting SGLT2i, proteinuria, estimated glomerular filtration rate (eGFR) at the time of starting SGLT2i. Follow up data regarding proteinuria, eGFR and complications were collected.

Results:

A total of 24 patients were identified who had been prescribed SGLT2i (Dapagliflozin or Empagliflozin). 50% of them were non diabetic. The median duration post transplant when SGLT2i was started was 10.5 years, with the earliest being 1 year post transplant. All were living donor transplant recipients. The mean eGFR at initiation of SGLT2i was 62.6 ± 26 ml/min and average proteinuria was 916 mg/g (table 1). About one third patients were started on SGLT2i for graft IgA nephropathy. 20.8% were started on SGLT2i as an oral hypoglycemic agent in the absence of proteinuria. 45.8% were started for other causes of proteinuria, which included chronic allograft nephropathy (Figure 1). 54.2% were on Dapagliflozin 10 mg, 33.3% on Dapagliflozin 5 mg and 12.5% on Empagliflozin 25 mg (Figure 2)

Median duration of follow up was 11.5 months. Median proteinuria showed significant reduction from 916 mg/g to 685 mg/g after starting SGLT2i (p=0.05) (Table3). 

Three (12.5%) patients developed urinary tract infection (UTI) during the follow up period, among them 2 had recurrent UTI and SGLT2i was stopped (Table 2). None of the patients had any hospitalization due to UTI, euglycemic ketosis or urogenital fungal infection in this study.

Conclusions:

This study highlights the significant protein lowering effect of SGLT2i in the renal transplant recipients with no major adverse events. SGLT2i can be safely prescribed in the renal transplant recipients both as an oral hypoglycemic agent and more importantly as an anti-proteinuric agent with possible improvement in long term graft outcomes.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.