Empagliflozin in kidney transplant recipients with chronic kidney disease G3a-4 and metabolic syndrome: Five Japanese cases

Abstract

Background Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to exert cardiorenal protective effects in diabetic patients and are widely used clinically. In addition, an increasing number of reports now suggest these drugs may even be beneficial in non-diabetic patients. However, SGLT2 inhibitors are rarely prescribed for kidney transplant recipients due to the risk of renal graft damage and urogenital infections. Case presentation We report the cases of 5 renal transplant recipients with chronic kidney disease G3a-4 and metabolic syndrome who were administered the SGLT2 inhibitor empagliflozin, which yielded beneficial results in 4 cases. With the exception of one patient with an initial estimated glomerular filtration rate (eGFR) of less than 30 ml/min/1.73 m2, administration of empagliflozin elicited beneficial metabolic effects. There were no significant reductions in eGFR before or after empagliflozin administration, and no dehydration or urogenital infections were observed during the treatment course. Conclusion Empagliflozin showed some positive effects in 4 cases with better renal function than CKD stage 4. Further studies will be required to clarify the efficacy and safety of SGLT2 inhibitors in a larger group of patients with similar medical conditions.

Use of Sodium-Glucose Cotransporter-2 Inhibitor for Diabetes Management in Patients Following Kidney Transplantation

“…For instance, a Japanese study detailing the use of empagliflozin in 5 KTR found that A1c decreased in only 3 cases, and a case-control analysis comparing SGLT2 inhibitors versus other oral hypoglycemic agents found a mean change of −0.1% in the SGLT2 inhibitor group versus −0.2% in the control group ( P = 0.527). 27,28 Similarly, 1 final retrospective study also showed a nonsignificant change in A1c of −0.53% at 6 months ( P = 0.1189) with a change in insulin dose of −3.7 units ( P = 0.17) reported as an additional primary outcome. 26…”

“…25,26 The case-control analysis comparing SGLT2 inhibitors with other oral hypoglycemic agents had a mean change of −0.7 kg in the group receiving an SGLT2 inhibitors versus +1.6 kg in the control group at 48 weeks ( P = 0.04). 27 Moderate reductions in weight were observed in the remaining retrospective articles, including an average decrease of 2.4 kg after a year of empagliflozin use, a mean loss of 2.14 kg with canagliflozin use, and a median decrease of 1.6 kg after 3 months of any SGLT2 inhibitors. 21,23,24 The final retrospective case series reporting on weight found a decrease in body weight and waist circumference in 4 of 5 empagliflozin-treated, Japanese KTR.…”

“…22 Of the retrospective studies, A1c reduction was consistently observed, but only 2 studies found the change to be statistically significant. 21 -28 In these studies, the use of SGLT2 inhibitors resulted in a modest overall decrease in A1c at 12 months. The change ranged from 0.5% to 1.0% reduction ( P < 0.05) in the initial publication and a median A1c decrease of −0.4% ( P = 0.016) in the second.…”

“…Eight case series/retrospective analysis, 4 prospective cohort studies, and 1 RCT were included in this review (Figure 1). [21][22][23][24][25][26][27][28][29][30][31][32][33]…”

Collaboration between local nephrologists and the transplant centre ensures good outcomes in post-transplant care

“…The progress of therapeutic drug monitoring for mycophenolic acid, which is becoming more common in clinical practice, helps better monitor and adequately dose immunosuppressive treatment [ 22 ]. Also, in the diagnosis of recurrent/de novo glomerulonephritis, new therapeutic options are available to slow down the loss of function of the transplanted kidney, on the one hand by the possibility of inclusion in studies in complement-mediated diseases, but also in general by the use of new nephroprotective approaches with sodium–glucose cotransporter-2 inhibitors [ 28–30 ]. Concerning the histologic diagnosis of CNI-associated nephrotoxicity, the recently published data on conversion from CNI-based to belatacept-based immunosuppression notably support early histological diagnosis to minimize the irreversibility of damage [ 31 , 32 ].…”