Use of Sodium-Glucose Cotransporter-2 Inhibitors in Renal Transplant Patients With Diabetes: A Brief Review of the Current Literature

Shuster, Shirley; Al-Hadhrami, Zeyana; Moore, Sarah; Awad, Sara; Shamseddin, M. Khaled

doi:10.1016/j.jcjd.2021.06.003

Cited by 8 publications

(12 citation statements)

References 38 publications

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“…This increases tubuloglomerular feedback leading to vasoconstriction of the afferent arterioles causing a reduction in intraglomerular pressure. This reduces albuminuria, renal inflammation, and tubular oxygen demand for reabsorption [19]. In addition to the hemodynamic mechanisms, decreased arterial stiffness, reduction in body weight, and inhibition of sympathetic nervous system activity by SGLT2i is associated with lower blood pressure [20][21][22] (Fig.…”

Section: Mechanisms Of Action Of Sodium-glucose Cotransporter 2 Inhib...mentioning

confidence: 99%

Sodium-glucose cotransporter 2 inhibitors and cardiorenal outcomes in kidney transplantation

Mahalwar,

Mathew,

Rangaswami

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review This review aims to explore the current evidence regarding cardiovascular and kidney outcomes in patients who undergo treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i) post kidney transplantation. Recent findings Summary findings from individual studies included in this review showed largely favorable results in the kidney transplant recipients (KTRs) being treated with SGLT2i.These outcomes included parameters such as allograft function, glycemic control, proteinuria, blood pressure, weight loss and safety profile, among others. Almost all the studies reported an initial ‘dip’ in eGFR, followed by recovery, after the initiation of SGLT2i treatment. None of the studies reported significant interaction of SGLT2i with immunosuppressive medications. The most common adverse effects noted in these studies were infection-related including UTI and genital mycosis. None of the studies reported acute graft rejection attributable to SGLT2i therapy. Summary SGLT2i can play a significant role in improving health outcomes in KTRs. However, clinical trials with larger representation of KTRs longer follow-up period are needed to draw more substantial conclusions.

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Section: Mechanisms Of Action Of Sodium-glucose Cotransporter 2 Inhib...mentioning

confidence: 99%

Sodium-glucose cotransporter 2 inhibitors and cardiorenal outcomes in kidney transplantation

Mahalwar,

Mathew,

Rangaswami

2023

Current Opinion in Nephrology &Amp; Hypertension

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“…A review of 9 studies, including 144 KT patients with diabetes, reported that SGTL2 inhibition resulted in a modest improvement in glycemic control, weight reduction, small reduction in blood pressure and stable renal allograft function. No serious side effects were reported [ 28 ]. In KT recipients, an improvement of glycemic control has been observed when SGLT2 inhibitors were added to other antidiabetic medications [ 29 , 30 ].…”

Section: Post-transplant Diabetes Mellitusmentioning

confidence: 99%

Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden

Reggiani

Moroni

Ponticelli³

2022

JPM

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Background. Cardiovascular disease is a frequent complication after kidney transplantation and represents the leading cause of mortality in this population. Material and Methods. We searched for the relevant articles in the National Institutes of Health library of medicine, transplant, cardiologic and nephrological journals. Results. The pathogenesis of cardiovascular disease in kidney transplant is multifactorial. Apart from non-modifiable risk factors, such as age, gender, genetic predisposition and ethnicity, several traditional and non-traditional modifiable risk factors contribute to its development. Traditional factors, such as diabetes, hypertension and dyslipidemia, may be present before and may worsen after transplantation. Immunosuppressants and impaired graft function may strongly influence the exacerbation of these comorbidities. However, in the last years, several studies showed that many other cardiovascular risk factors may be involved in kidney transplantation, including hyperuricemia, inflammation, low klotho and elevated Fibroblast Growth Factor 23 levels, deficient levels of vitamin D, vascular calcifications, anemia and poor physical activity and quality of life. Conclusions. The timely and effective treatment of time-honored and recently discovered modifiable risk factors represent the basis of the prevention of cardiovascular complications in kidney transplantation. Reduction of cardiovascular risk can improve the life expectancy, the quality of life and the allograft function and survival.

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“…There is an increasing interest in the use of SGLT2 inhibitors in kidney transplant (KTx) recipients, although there are concerns regarding associated risk of dehydration and urinary tract infections 6 . Based on the limited evidence from prospective or retrospective case series, a small randomized control trial, and their meta‐analysis, 7–11 SGLT2 inhibitors appear to be well‐tolerated and efficient in weight loss and glycemic control without increasing the risk of hypoglycemia or other significant adverse events in the KTx population, 12 and potentially useful in reducing mortality and preserving graft function 13 . In addition, increased serum magnesium levels with SGLT2 inhibitors 6,8 may add another benefit in KTx recipients with hypomagnesemia, which reportedly contributes to mortality risk 14 …”

Section: Introductionmentioning

confidence: 99%

Sociodemographic disparities in sodium‐glucose cotransporter‐2 inhibitor use among US kidney transplant recipients: An observational study of real‐world pharmacy records

Lentine,

Miyata,

Lam

et al. 2024

Clinical Transplantation

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BackgroundRecent clinical trials demonstrate benefits of sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) in patients with chronic kidney disease, but data on use in kidney transplant (KTx) recipients are limited.MethodsWe examined a novel database linking SRTR registry data for KTx recipients (2000–2021) with outpatient fill records from a large pharmaceutical claims warehouse (2015–2021). Adult (≥18 years) KTx recipients treated with SGLT2i were compared to those who received other noninsulin diabetes medications without SGLT2i. Characteristics associated with SGLT2i use were quantified by multivariable logistic regression (adjusted odds ratio, 95%LCLaOR95%UCL).ResultsAmong 18 988 KTx recipients treated with noninsulin diabetes agents in the study period, 2224 filled an SGLT2i. Mean time from KTx to prescription was 6.7 years for SGLT2i versus 4.7 years for non‐SGLT2i medications. SGLT2i use was more common in Asian adults (aOR, 1.091.311.58) and those aged > 30–59 years (compared with 18–30 years) or with BMI > 35 kg/m2 (aOR, 1.191.411.67), and trended higher with self‐pay status. SGLT2i use was lower among KTx recipients who were women (aOR, .79.87.96), Black (aOR, .77.881.00) and other (aOR, .52.751.07) race, publicly insured (aOR, .82.921.03), or with less than college education (aOR, .78.87.96), and trended lower in those age 75 years and older. SGLT2i use in KTx patients increased dramatically in 2019–2021 (aOR, 5.015.636.33 vs. prior years).ConclusionSGLT2i use is increasing in KTx recipients but varies with factors including race, education, and insurance. While ongoing study is needed to define risks and benefits of SGLT2i use in KTx patients, attention should also focus on reducing treatment disparities related to sociodemographic traits.

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Use of Sodium-Glucose Cotransporter-2 Inhibitors in Renal Transplant Patients With Diabetes: A Brief Review of the Current Literature

Cited by 8 publications

References 38 publications

Sodium-glucose cotransporter 2 inhibitors and cardiorenal outcomes in kidney transplantation

Sodium-glucose cotransporter 2 inhibitors and cardiorenal outcomes in kidney transplantation

Cardiovascular Risk after Kidney Transplantation: Causes and Current Approaches to a Relevant Burden

Sociodemographic disparities in sodium‐glucose cotransporter‐2 inhibitor use among US kidney transplant recipients: An observational study of real‐world pharmacy records

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