Abstract: TH-PO939

Sodium/Glucose Cotransporter 2 (SGLT2) Inhibitor for Diabetic Kidney Transplant (KT) Patients

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Kwon, Hyuk yong, BHS-Hanseo hospital, Busan, Korea (the Republic of)
  • Kong, Jin M., BHS-Hanseo hospital, Busan, Korea (the Republic of)
Background

SGLT2 inhibitor is a newly introduced hypoglycemic drug that inhibits glucose reabsorption at proximal tubule. A recent RCT in diabetic CKD patients showed a long-term renoprotective effect, by a decrease in hyperfiltration as a consequence of increased distal sodium delivery with tubuloglomerular feedback. This result seems relevant to KT patients where reduced nephron mass may suffer from hyperfiltration that jeopardizes long term graft survival. But the experience of this drug in KT patients is limited and there are concerns of lower urinary tract infection and acute graft dysfunction due to volume depletion by osmotic diuresis as well as reduction in intraglomerular pressure. The aim of this study is to evaluate the safety and efficacy of SGLT2 inhibitor in KT patients.

Methods

Twenty-five KT patients were treated with dapagliflozin 5mg/d. Three patients had type 1 DM and 7 had NODAT. Sixteen patients were on insulin with or without oral agents. Median posttransplant months were 72(9-262). Diuretics were stopped before the initiation of study drug.

Results

Baseline HbA1c was 7.9±1.3%, decreased significantly at 3(7.4±1.1%, p=0.01) and 6(7.4±1.0%) months(M). Body weight decreased significantly from 72.2±22.1 to 68.1±22.0(p=0.001)kg at 12M. Two patients could stop insulin and another 4 patients could reduce ≥20% dose of insulin. eGFR did not change significantly (71.1±20.1ml/min at baseline, 71.5±25.8 at 12M). Clinically apparent acute graft dysfunction was not observed. Office blood pressure also was not changed significantly but 10 of 24 patients had a decrease in number and/or dose of anti-hypertensives. No significant change in urine albumin-creatinine ratio at 1 year. Six patients discontinued study drug due to acute cystitis in 2, weight loss in 1 and lack of efficacy in 3.

Conclusion

SGLT2 inhibitor seems to be beneficial in glucose control of KT patients, with acceptable safety profile. Further studies are clearly needed to determine the possible long-term renoprotective effect in this patient population.