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Kidney Week

Abstract: SA-OR61

Outcomes Associated with Sodium-Glucose Cotransporter-2 Inhibitors in Kidney Transplant Recipients: A Real-World Analysis Using a Global Federated Database

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Anwar, Nageen, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  • Davies, Elin, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  • Devonald, Mark A.J., Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  • Lip, Gregory Y.H., University of Liverpool Faculty of Health and Life Sciences, Liverpool, United Kingdom
  • Mcdowell, Garry, Liverpool John Moores University, Liverpool, United Kingdom
  • Rao, Anirudh, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
Background

Several trials have shown the effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in cardiovascular events and its nephroprotective effects among patients with native kidney disease, but little is known about the safety and efficacy of SGLT2i in the kidney transplant setting. The study aimed to investigate the benefits of SGLT2i in kidney transplant recipients.

Methods

A retrospective cohort study was performed of adult renal transplant patients (≥ 18 years) using electronic medical records from a TriNetX database searched on 19th May 2023. Cohorts were grouped by receipt of SGLT2i and 1:1 propensity-score matched for demography (age, gender, & ethnicity), baseline co-morbidities (cardiovascular disease, diabetes mellitus & smoking status), laboratory data (estimated glomerular filtration rate & proteinuria) and immunosuppression. Logistical regression produced odds ratios with 95%CI for incident 3-year graft failure, rejection, major adverse cardiac events (MACE), all-cause mortality, and genitourinary infections. All statistical analyses were performed on the TriNetX online platform.

Results

The propensity score matching identified 3,450 patients (Mean age 59.4 SD± 11.9, 65% Male), each in the SGLT2i and non-SGLT2i treated renal transplant cohorts.
The table shows the outcomes, odds ratio (OR), and 95% confidence interval (CI) for the SGLT2i and non-SGLT2i treated renal transplant patients 3 years post-index event.

Conclusion

Kidney transplant patients treated with SGLT2i demonstrated a significant reduction in graft failure, rejection, MACE, all-cause mortality, and genitourinary infections. These data call for a Randomized Control Trial to evaluate the long-term kidney and cardiovascular outcomes of SGLT2i therapy in the renal transplant setting.

OutcomeCohortsNumber with outcomeOdds Ratio (OR)95% CIP-value
Kidney Transplant Failurenon- SGLT2i346---
SGLT2i820.250.20-0.32< 0.0001
Kidney Transplant Rejectionnon- SGLT2i695---
SGLT2i1860.280.23-0.33< 0.0001
Major Adverse Cardiac Eventsnon- SGLT2i503---
SGLT2i1730.390.31-0.47< 0.0001
All-Cause Mortalitynon- SGLT2i577---
SGLT2i1810.360.30-0.43< 0.0001
Genitourinary Infectionsnon- SGLT2i472---
SGLT2i1660.370.31-0.45< 0.0001