#6674 SAFETY AND EFFICACY OF SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS IN KIDNEY TRANSPLANT PATIENTS WITH TYPE 2 OR POST-TRANSPLANT DIABETES
Authors: Sánchez Luis Alberto Vigara , Alonso Marta , Amaro Jose Manuel , Fernández Florentino Villanego , Alonso Myriam Eady , Márquez Maria Gabriela Sánchez , Jiménez María Belén García , Orellana Cristhian , Garcia Teresa , Mazuecos Auxiliadora 
Published: June 2023

Abstract

Background and Aims
Diabetes mellitus (DM) is a complication in kidney transplant (KT) patients, leading to a higher cardiovascular mortality and graft loss. Therapies such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown a cardioprotective and nephroprotective effect and may offer benefits in KT. The aim of our study is to describe the effectiveness and safety of SGLT2i in KT patients.

Method
Retrospective cohort study of KT with DM who started SGLT2i in three Spanish hospitals (Puerta del Mar University Hospital, Jerez de la Frontera University Hospital and Puerto Real University Hospital) between May 2018 and December 2022. Clinical and demographic variables were analyzed. We collected SGLT2i type and dose. Glomerular filtration rate (eGFR), proteinuria, and weight were collected at the start of treatment and after 6 and 12 months. We analyze glycemic control, blood pressure, lipid profile and magnesium, uric acid and hemoglobin levels. We document adverse effects. Parametric and non-parametric tests were performed according to the normality of the sample.

Results
In this period, 57 KT with DM were treated with SGLT2i, of which thirty-five (61%) patients had developed post-transplant diabetes mellitus (PTDM). Fifty-one patients completed a minimum follow-up of 6 months and thirty-six patients 1 year. At the start of the treatment the mean age was 62 years and 65% were men. Mean baseline estimated glomerular filtration rate (eGFR) was 54.5 ml/min/1.73 m2 and the time post-KT was 44 months. The median proteinuria measured by the albumin-creatinine ratio in isolated urine was 83.2 mg/g. The mean weight was 91 kg. The SGLT2i mostly prescribed was empagliflozin (58%). The maintenance immunosuppressive therapy included steroids (94%), tacrolimus (96%), mycophenolate (84%), everolimus (19%) and cyclosporine (2%). Glomerular filtration rate and proteinuria remained unchanged during all the follow-up. In our cohort, body weight significantly reduced (−2.6 Kg at 6 months, p = .007 and −2.1 Kg at 12 months, p = .073). Furthermore, HbA1c (−1.2 mmol/L at 6 months) and faster blood sugar levels (−21.7 mg/dl at 6 months, p = .006 and 14.3 mg/dl at 12 months) decreased. On the other hand, we observed a reduction in LDL-cholesterol (−6 mg/dl at 6 months, p = 0.033 and −11.5 mg/dl at 12 months, p = 0.012). Finally, we observe a reduction in uric acid levels (−0.4 mg/dl at 6 months, p = 0.081) and an improvement in magnesium (+0.07 mg/dl at 6 months, p = 0.021) and haemoglobin levels (+0.3 g/dl at 6 months, p = 0.001). We found no differences in antihypertensive, diuretics, antidiabetic, lipid-lowering drugs and doses of epoetin alfa during the follow-up. Regarding adverse effects, 8 patients suffered urinary tract infections (UTIs) after starting the drug and one of them required hospital admission. Three patients had to discontinue the drug due to impaired renal function.

Conclusion
SGLT2i may be an option for the management of DM in KT patients, improving glycemic control and cardiovascular risk factors. An adequate selection, hygienic recommendations and surveillance of urinary infections are important.