Abstract: FR-PO811
One Year Outcome of SGLT2 Inhibitors Amongst Diabetic Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Outcomes
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Song, Chelsey, Virginia Commonwealth University, Richmond, Virginia, United States
- Brown, Andrew, Virginia Commonwealth University, Richmond, Virginia, United States
- Winstead, Ryan, Virginia Commonwealth University, Richmond, Virginia, United States
- Sterling, Sara, Virginia Commonwealth University, Richmond, Virginia, United States
- Christensen, Johanna L., Virginia Commonwealth University, Richmond, Virginia, United States
- Yakubu, Idris, Virginia Commonwealth University, Richmond, Virginia, United States
- Gupta, Gaurav, Virginia Commonwealth University, Richmond, Virginia, United States
Background
The use of Sodium Glucose Linked Transporter Inhibitors (SGLT-2i) among non-transplant diabetic patients with chronic kidney disease (CKD) have demonstrated reduced cardiovascular mortality and delayed CKD progression. As more published data has validate the early safety outcomes of SGLT-2i, there is currently a lack of evidence on the long term renal benefits amongst kidney transplant (KT) recipients and its impact on kidney function, and metabolic outcomes. We aimed to bridge this knowledge gap and report our 12 months experience with SGLT-2i at our center.
Methods
This was a single center, retrospective study conducted in adult KT recipients who met SGLT-2i initiation criteria at our center. Patients were eligible if they had type II diabetes (pre-existing or new onset post-transplant); no AKI ≤30 days prior to drug initiation; and an estimated glomerular filtration rate (eGFR) > 25 mL/min. Primary outcomes were changes in weight, hemoglobin A1C (HgA1C), and eGFR. Secondary outcomes included rates of treated urinary tract infections (UTIs), diabetic ketoacidosis (DKA), amputations, and sever. Choice of the specific SGLT-2i agent was based upon insurance preference.
Results
123 patients met enrollmemnt criteria.The median time to initiation from transplant was 250 days (IQR 88-887). The mean change in eGFR from the time of initiation to 6 and 12 months of therapy was 2.95 mL/min [(SD:14.8, p=0.04(CI:0.19,5.72)] and 4.09 mL/min [(SD:17.7, p=0.02 (CI: 0.60,7.57))]. There were also significant improvement in weight by -1.35 kg [(SD 3.27, p=0.001 (CI:-0.75, -1.96))] over the course of 12 months. Mean change in HgbA1c was 0.05 [(SD 1.72, p=0.759 (CI: -0.28, 0.39))]. Of those, 112 (91%) received empagliflozin, 2 (2%) canagliflozin, and 9 (7%) dapagliflozin. Overall 1 patient had euglycemic DKA, and 18 (15%) experienced UTI, none of the patients experienced amputations or hospitalizations due drug induced AKI.
Conclusion
Amongst diabetic KT patients, we found that patients who were treated SGLT-2i had statistically significant improvement in eGFR at 6 and 12 months. The risk of adverse events with SGLT-2i initiation post-kidney transplant were comparable with previously published data and confer a trend towards both improvement in renal function and metabolic profile.