Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes
Background: Sodium-glucose co-tranporter-2 inhibitors have been shown to be safe and effective in patients with type 2 diabetes for improving glycemia. Furthermore large, randomized control trials have shown cardiovascular and renal benefits. However, limited safety and efficacy data is available in...
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| Format: | Article |
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SAGE Publishing
2024-11-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/20543581241293202 |
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| author | Albi Angjeli Tess Montada-Atin Rosane Nisenbaum Niki Dacouris Michelle Nash G.V. Ramesh Prasad Jeffrey Zaltzman |
| author_facet | Albi Angjeli Tess Montada-Atin Rosane Nisenbaum Niki Dacouris Michelle Nash G.V. Ramesh Prasad Jeffrey Zaltzman |
| author_sort | Albi Angjeli |
| collection | DOAJ |
| description | Background: Sodium-glucose co-tranporter-2 inhibitors have been shown to be safe and effective in patients with type 2 diabetes for improving glycemia. Furthermore large, randomized control trials have shown cardiovascular and renal benefits. However, limited safety and efficacy data is available in kidney transplant patients with diabetes. Objective: To investigate the safety and efficacy of SGLT2i use on stability of renal function in adult kidney transplant recipients (KTR) with type 2 diabetes mellitus (DM2) or New Onset Diabetes After Transplantation (NODAT). Design: We performed a single center, retrospective cohort study pre- and post-SGLT2i exposure. Patients: Adults with DM2 or NODAT who received a living or deceased kidney transplant (Tx) and started on an SGLT2i post-Tx were reviewed. Patients who had type 1 diabetes were excluded. Measurements and Methods: The baseline was the SGLT2i start date. We reviewed available data from 24 months (M) before and after SGLT2i initiation. The primary endpoints were the effects of SGLT2i use on stability of renal function using serum creatinine and eGFR, change in urine albumin excretion(uACR), and glycosylated hemoglobin (A1C). Secondary endpoints compared blood pressure, body mass index and adverse reactions at baseline and quarterly after SGLT2i initiation. Results: 125 KTRs were included in cohort: NODAT (52, 42%), DM2 (73, 58%); female (33, 27%); mean age at Tx 55 years (25-75); LD (56, 45%), DD (69, 55%); mean duration of Tx (6.8 years, 0.1-42.5); study follow-up (1.8 years, 0.3-4.9). The mean eGFR remained stable pre-SGLT2i at 64.6 mL/min/1.73m 2 , vs post at 64.3 mL/min/1.73m 2 . There was no difference in mean A1C after SGLT2i initiation. The slope of uACR using natural log transformation pre-SGLT2i compared with post-SGLT2i slope reduced from +0.7 (0.03, 0.11) to -0.04 (-0.01, -0.35) mg/mmol/3mths ( P = .002). The risk of developing new genital mycotic infections among all patients was 4% (95% CI 1.3%-9.1%) While there was no significant difference in UTI before (13.6%) and after (12%) SGLT2i use ( P = .68), there was a higher risk of UTI seen in patients with a previous history of UTI (23.5%) vs no previous history (10.2%) post initiation. There was no significant increase in AKI pre 8%, post 10.4%, P = .51. There was a single DKA event pre- and post-SGLT2. Limitations: The limitations of this study include its retrospective nonrandomized nature. Conclusion: In this retrospective analysis, SGLT2i use in KTR appears to be safe and efficacious with stable renal function and glycemic control, alongside improvements in uACR. There was a low risk of new genital yeast infections after SGLT2i start. UTI occurrence was higher in patients with a previous history of UTI compared with those with no previous history. |
| format | Article |
| id | doaj-art-291e642837464539b91bc69d5f7c2267 |
| institution | Kabale University |
| issn | 2054-3581 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj-art-291e642837464539b91bc69d5f7c22672024-11-11T14:03:30ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812024-11-011110.1177/20543581241293202Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With DiabetesAlbi Angjeli0Tess Montada-Atin1Rosane Nisenbaum2Niki Dacouris3Michelle Nash4G.V. Ramesh Prasad5Jeffrey Zaltzman6Kidney Research Program, St. Michael’s Hospital, Unity Health Toronto, ON, CanadaLawrence Bloomberg Faculty of Nursing, University of Toronto, ON, CanadaApplied Health Research Centre, St. Michael’s Hospital, Unity Health Toronto, ON, CanadaKidney Research Program, St. Michael’s Hospital, Unity Health Toronto, ON, CanadaKidney Research Program, St. Michael’s Hospital, Unity Health Toronto, ON, CanadaDivision of Nephrology, University of Toronto, ON, CanadaDivision of Nephrology, University of Toronto, ON, CanadaBackground: Sodium-glucose co-tranporter-2 inhibitors have been shown to be safe and effective in patients with type 2 diabetes for improving glycemia. Furthermore large, randomized control trials have shown cardiovascular and renal benefits. However, limited safety and efficacy data is available in kidney transplant patients with diabetes. Objective: To investigate the safety and efficacy of SGLT2i use on stability of renal function in adult kidney transplant recipients (KTR) with type 2 diabetes mellitus (DM2) or New Onset Diabetes After Transplantation (NODAT). Design: We performed a single center, retrospective cohort study pre- and post-SGLT2i exposure. Patients: Adults with DM2 or NODAT who received a living or deceased kidney transplant (Tx) and started on an SGLT2i post-Tx were reviewed. Patients who had type 1 diabetes were excluded. Measurements and Methods: The baseline was the SGLT2i start date. We reviewed available data from 24 months (M) before and after SGLT2i initiation. The primary endpoints were the effects of SGLT2i use on stability of renal function using serum creatinine and eGFR, change in urine albumin excretion(uACR), and glycosylated hemoglobin (A1C). Secondary endpoints compared blood pressure, body mass index and adverse reactions at baseline and quarterly after SGLT2i initiation. Results: 125 KTRs were included in cohort: NODAT (52, 42%), DM2 (73, 58%); female (33, 27%); mean age at Tx 55 years (25-75); LD (56, 45%), DD (69, 55%); mean duration of Tx (6.8 years, 0.1-42.5); study follow-up (1.8 years, 0.3-4.9). The mean eGFR remained stable pre-SGLT2i at 64.6 mL/min/1.73m 2 , vs post at 64.3 mL/min/1.73m 2 . There was no difference in mean A1C after SGLT2i initiation. The slope of uACR using natural log transformation pre-SGLT2i compared with post-SGLT2i slope reduced from +0.7 (0.03, 0.11) to -0.04 (-0.01, -0.35) mg/mmol/3mths ( P = .002). The risk of developing new genital mycotic infections among all patients was 4% (95% CI 1.3%-9.1%) While there was no significant difference in UTI before (13.6%) and after (12%) SGLT2i use ( P = .68), there was a higher risk of UTI seen in patients with a previous history of UTI (23.5%) vs no previous history (10.2%) post initiation. There was no significant increase in AKI pre 8%, post 10.4%, P = .51. There was a single DKA event pre- and post-SGLT2. Limitations: The limitations of this study include its retrospective nonrandomized nature. Conclusion: In this retrospective analysis, SGLT2i use in KTR appears to be safe and efficacious with stable renal function and glycemic control, alongside improvements in uACR. There was a low risk of new genital yeast infections after SGLT2i start. UTI occurrence was higher in patients with a previous history of UTI compared with those with no previous history.https://doi.org/10.1177/20543581241293202 |
| spellingShingle | Albi Angjeli Tess Montada-Atin Rosane Nisenbaum Niki Dacouris Michelle Nash G.V. Ramesh Prasad Jeffrey Zaltzman Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes Canadian Journal of Kidney Health and Disease |
| title | Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes |
| title_full | Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes |
| title_fullStr | Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes |
| title_full_unstemmed | Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes |
| title_short | Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes |
| title_sort | single center experience with sodium glucose co transporter 2 inhibitors sglt2i in kidney transplant recipients with diabetes |
| url | https://doi.org/10.1177/20543581241293202 |
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