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Abstract: FR-PO807

Safety of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Diabetic Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Mahmoud, Tarek Said Hamed, Hamed Al-Essa Transplant Center, Kuwait City, Kuwait
  • Yagan, Jude A., Hamed Al-Essa Transplant Center, Kuwait City, Kuwait
  • Hasan, Amal, Dasman Diabetes Institute, Kuwait City, Kuwait
  • Gheith, Osama, Hamed Al-Essa Transplant Center, Kuwait City, Kuwait
  • Mostafa, Mohamed M., Hamed Al-Essa Transplant Center, Kuwait City, Kuwait
  • Rida, Suzann, Hamed Al-Essa Transplant Center, Kuwait City, Kuwait
  • Shaker, Mohamed, Hamed Al-Essa Transplant Center, Kuwait City, Kuwait
  • Abdrabou, Mahmoud Mohammed Mahmoud Khalid, Hamed Al-Essa Transplant Center, Kuwait City, Kuwait
Background

Kidney transplant recipients (KTRs) with type 2 diabetes (T2D) have poorer cardiovascular and renal outcomes. The favorable impact of the new glucose lowering therapies like sodium–glucose cotransporter 2 inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor agonists (GLP-1RA) on patients with T2D is clearly evident now based on the recent outcome trials. However, there is inertia in using these drugs for KTRs due to the fear of their side effects and the absence of clear guidelines. We retrospectively assessed the efficacy, safety and short-term outcomes of these drugs.

Methods

We collected one year follow up data from records of 98 diabetic KTRs who received SGLT2I and 41 who received GLP-1RA in addition to standard of care therapy (SOC) for at least 3 months. We compared them to 70 diabetic KTRs who were on only SOC. Patients were over 3 months post-transplant with minimum estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73m2. No significant difference in the demographics between the groups except for a lowish HbA1c in the control group (8.0% versus 7.2%)

Results

HbA1c dropped by 0.4% in SGLT2i (p=0.0001) and GLP-1RA (p=0.0003) compared to only 0.05% in the control group. BMI decreased by 0.32 (p=0.0450) in SGLT2i and 0.34 (p=0.0105) in GLP-1RA compared to an increase by 0.015 in control group. There was a tendency for better eGFR by the end of the year in both study groups (figure 1) though it was not statistically significant except for KTRs on SGLT2i with eGFR more than 90 ml/min (p=0.0135). A dip in eGFR was observed in SGLT2i group at 1 and 3 months. Albuminuria was significantly reduced at 12 months in SGLT2i by a median of 28 mg/mmol (p=0.0095) and by 20 mg/mmol in GLP-1RA (p=0.0072) compared to increase by 3.4 mg/mmol in control group (figure 2). Adverse events were minimal.

Conclusion

Use of SGLT2i and GLP-1RA appears to be safe in diabetic KTRs with good outcome. Randomized control trials are required to confirm these findings and establish guidelines.