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Kidney Week

Abstract: TH-PO152

Empagliflozin in Posttransplantation Diabetes Mellitus: Effect on Glucose Metabolism and Fluid Volume

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Hecking, Manfred, Medical University of Vienna, Nephrology & Dialysis, Vienna, Austria
  • Schwaiger, Elisabeth, Medical University of Vienna, Nephrology & Dialysis, Vienna, Austria
  • Signorini, Lorenzo, Azienda ospedaliera universitaria integrata - ospedale civile di Verona, Sommacampagna, Italy
  • Ristl, Robin, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
  • Tura, Andrea, Institute of Neuroscience, Padova, Italy
  • Pacini, Giovanni, Institute of Neuroscience, Padova, Italy
  • Kopecky, Chantal Maureen, Medical University of Vienna, Nephrology & Dialysis, Vienna, Austria
  • Antlanger, Marlies, Medical University of Vienna, Nephrology & Dialysis, Vienna, Austria
  • Werzowa, Johannes, 1st Medical Department, Hanusch Hospital, Vienna, Austria
  • Saemann, Marcus D., Wilhelminen Hospital, Vienna, Austria
Background

Empagliflozin decreases cardiovascular morbidity and mortality in type 2 diabetics, but safety and efficacy in patients with posttransplant diabetes mellitus (PTDM) is unknown.

Methods

We conducted a prospective non-inferiority trial, converting stable kidney transplant recipients with PTDM from insulin (<40 IU/day) to 10 mg empagliflozin, aiming at eliminating exogenous insulin. Oral glucose tolerance tests, fluid volume status and adverse events were compared from baseline to 4 weeks after empagliflozin conversion (clinicaltrials.gov:NCT03113110).

Results

14 patients (the required sample size, using change in intra-individual 2-hour glucose as primary endpoint) completed the study visits. The primary endpoint was negative (p=0.06) but glucose control was clinically inferior after insulin withdrawal (27.2±10.5 IU/day; Figure & Table). Insulin sensitivity and bioimpedance spectroscopy-derived extracellular fluid volume decreased with empagliflozin therapy. No patient developed ketoacidosis, 3 had bacterial urinary tract infections (UTIs).

Conclusion

Despite risk of UTIs and moderatly inferior glucose control under empagliflozin monotherapy following exogenous insulin therapy, empagliflozin is a valuable antidiabetic for PTDM patients which should be studied as add-on therapy. Plasma volume contraction might contribute to the cardiovascular risk reduction observed in type 2 diabetics.