Expanding the Therapeutic Landscape: Sodium-Glucose Co-transporter 2 Inhibitors in Kidney Transplant Recipients

TL;DR

This review explores the use of SGLT2 inhibitors in kidney transplant patients, showing benefits for diabetics but highlighting the need for more research in non-diabetic and impaired renal function cases.

Contribution

The paper synthesizes current evidence on SGLT2i efficacy and safety in kidney transplant recipients, identifying gaps in non-diabetic and impaired renal function populations.

Findings

SGLT2i improve glycaemic control, reduce proteinuria, and preserve renal function in diabetic transplant recipients.

SGLT2i have a good safety profile, with urinary tract infections as the main side effect.

Evidence for non-diabetic transplant recipients is encouraging but insufficient for routine use.

Abstract

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are well-established oral antidiabetic agents, which also have an important role in slowing the progression of chronic kidney disease and providing cardiovascular protection, particularly in patients with heart failure. The use of SGLT2i in renal transplant recipients is of growing clinical interest; however, the majority of supporting evidence highlighting their efficacy and safety in this population comes from small, retrospective observational studies rather than large randomized trials. This review synthesizes current evidence on the efficacy and safety of SGLT2i in renal transplant recipients, including both diabetic and non-diabetic individuals. Literature search was carried out on multiple databases using a combination of both keywords and free-text search. There is strong evidence from several studies to support a beneficial role of SGLT2i in diabetic renal transplant patients in terms of improving glycaemic control, reducing proteinuria, preserving renal allograft function, and in reducing the risk of major adverse cardiovascular and renal effects and mortality in transplant recipients. There is encouraging but insufficient evidence to support the routine use of SGLT2i in non-diabetic renal transplant recipients, and there is a significant literature gap regarding transplant patients with impaired renal function. SGLT2i appear to have a good safety profile with the predominant side effect being urinary tract infections, which were not significantly associated with allograft dysfunction or loss. Further studies are needed to clarify and validate the cardio-renal and metabolic benefits of SGLT2i in renal transplant recipients that are observed in other patient populations.