Sodium-Glucose Cotransporter-2 Inhibition in Kidney Transplant Patients

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, originally developed to improve glycaemic control in type 2 diabetes, have emerged as potent agents for cardiorenal protection. In kidney transplant recipients (KTRs), chronic allograft dysfunction and cardiovascular disease remain leading causes of morbidity and mortality. Recent investigations have explored whether SGLT-2 inhibition can confer the same benefits in this population without compromising graft function or precipitating adverse events. Early evidence suggests a multifaceted impact: attenuation of proteinuria, modest blood pressure reduction, correction of fluid overload and potential mitigation of both all-cause mortality and major cardiorenal events. Safety concerns—principally urogenital infections, immunosuppressive interactions and acute declines in graft filtration—have been carefully monitored, and current data indicate that, with appropriate patient selection and monitoring, SGLT-2 inhibitors can be integrated into post-transplant care to enhance long-term outcomes.

Research from Nature Portfolio

Recent studies have reported on a large cohort of diabetic KTRs treated with SGLT-2 inhibitors within the early post-transplant period. Analysis of a multinational electronic health-record database compared nearly two thousand users with matched non-users over a median follow-up of 3.4 years. Those receiving SGLT-2 inhibitors experienced substantially lower rates of all-cause mortality and reductions in major adverse cardiac and kidney events. The observed effect sizes remained significant after adjustment for key confounders, underscoring the potential of these agents to improve survival and reduce graft-related complications in diabetic KTRs.

Sodium-Glucose Cotransporter-2 Inhibition in Kidney Transplant Patients publication trend

The graph below shows the total number of articles in sodium-glucose cotransporter-2 inhibition in kidney transplant patients across all publications each year (not limited to Nature Index journals).

Technical terms

Sodium-glucose cotransporter-2 inhibitor (SGLT-2 inhibitor): A class of drugs that block renal reabsorption of filtered glucose, promoting glycosuria and natriuresis.

Estimated glomerular filtration rate (eGFR): A calculated index of kidney function based on serum creatinine, age, sex and race.

Major adverse cardiac events (MACE): A composite end point typically including myocardial infarction, stroke and cardiovascular death.

Major adverse kidney events (MAKE): A composite end point often comprising sustained decline in eGFR, initiation of dialysis or kidney-related death.

Proteinuria: The presence of excess protein in the urine, indicative of glomerular injury or filtration barrier dysfunction.

References

1. The outcomes of SGLT-2 inhibitor utilization in diabetic kidney transplant recipients. Nature Communications (2024).
2. Sodium-Glucose Cotransporter-2 Inhibitor in Diabetic and Nondiabetic Renal Transplant Recipients. Kidney International Reports (2024).
3. SGLT2 Inhibitors Correct Fluid Overload in Adult Kidney Transplant Recipients—A Prospective Observational Study. Transplant International (2024).