#1054 Impact of SLGT2 inhibitors in kidney transplant patients: a single center experience

Résumé fourni par la source

Abstract Background and Aims Recent landmark studies such as CREDENCE, EMPA-REG, and DAPA-CKD have demonstrated that sodium-glucose cotransporter-2 inhibitors (SGLT2i) are relatively safe, with minimal side effects, and provide substantial benefits in diabetic patients with chronic kidney disease (CKD). These benefits include reduced proteinuria, slower decline in kidney function, and decreased cardiovascular events and mortality. However, data on the effects of SGLT2i in diabetic kidney transplant recipients remain scarce. This study aims to evaluate the safety and efficacy of SGLT2i by comparing two groups of diabetic kidney transplant patients: those receiving SGLT2i versus those not receiving SGLT2i. Method This was an observational retrospective single-center study including an initial cohort of 473 diabetic kidney transplant recipients. Of these, we identified 45 patients who had been taking SGLT2i for at least six months. These patients were matched with a control group of 45 diabetic kidney transplant recipients who were not taking SGLT2i. Matching criteria included age, gender, baseline serum creatinine at the time of SGLT2i initiation, and time since transplantation. Exclusion criteria were patients with type 1 diabetes or other diabetes mellitus modalities (LADA or MODY) (n = 41); patients with multiple organ transplant (n = 7); patients taking SGLT2i for less of six months (n = 19) and patients who lost of follow-up (n = 6). Primary outcomes were assessed at 6 months and 12 months and included: changes in proteinuria, kidney function (measured by serum creatinine), body mass index and glycated haemoglobin. Secondary outcomes included adverse events (genito-urinary infections, acute limb ischemia, euglycemic ketoacidosis), major cardiovascular events (stroke, myocardial infarction, cardiovascular death) and overall mortality. A 95% confidence interval was used for statistical analysis. The Mann-Whitney test was applied for comparisons between groups. Results A total of 90 patients were included and divided into two groups (45 patients per group). The demographic characteristics are detailed in Table 1. No significant differences were observed between the groups regarding HbA1c reduction (6 months: p = 0.373; 12 months: p = 0.278) and BMI changes (6 months: p = 1.0; 12 months: p = 0.755). Kidney function (serum creatinine) showed no significant differences at 6 months (p = 0.681) or 12 months (p = 0.908). Proteinuria showed a statistically significant reduction at 6 months in the SGLT2i group (median reduction of 13 mg/g, p = 0.04) compared to a median increase of 60 mg/g in the control group. This reduction was not observed at 12 months, likely due to the smaller follow-up sample size. No side effects were detected in the SGLT2i group. In the control group, one patient required hospitalization due to complicated pyelonephritis. The mortality rate was 2.2% (n = 1) in the SGLT2i group, with the patient experiencing multiorgan dysfunction following complications from coronary artery bypass surgery. Conclusion These results supports the safety and potential efficacy of SGLT2i in kidney transplant patients. No significant adverse effects were observed in patients receiving SGLT2i, and a reduction in proteinuria was noted at 6 months. However, further larger-scale studies with longer follow-up periods are needed to confirm these findings and assess the long-term impact on allograft function, proteinuria, and cardiovascular outcomes.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.