Kidney Week

Abstract: FR-PO1059

Efficacy, Mechanisms, and Safety of SGLT2 Inhibitors in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - Pharmacology and Nonkidney Solid Organ Transplants
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Sridhar, Vikas, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada

Vikas Sridhar, MD

• Kugathasan, Luxcia, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Luxcia Kugathasan

• Lytvyn, Yuliya, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Yuliya Lytvyn, PhD

• Liu, Hongyan, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Hongyan Liu

• Deng, Yangqing, University Health Network, Toronto, Ontario, Canada

Yangqing Deng, PhD

• Lovblom, Leif Erik, University Health Network, Toronto, Ontario, Canada

Leif Erik Lovblom, PhD

• Nardone, Massimo, University Health Network, Toronto, Ontario, Canada

Massimo Nardone, PhD

• Chen, Yixiao, University Health Network, Toronto, Ontario, Canada

Yixiao Chen

• Hua, Jonathan J., University Health Network, Toronto, Ontario, Canada

Jonathan J. Hua

• Mohsen, Mai Hatem, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Mai Hatem Mohsen, MSc, RPh

• Yuen, Darren A., University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Darren A. Yuen, MD, PhD

• Kim, Joseph, University Health Network, Toronto, Ontario, Canada

Joseph Kim, MD, PhD, MBA

• Udell, Jacob A, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Jacob A Udell, MD, MPH

• Perkins, Bruce A., University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Bruce A. Perkins, MD, MPH

• Stevens, Jasper, Universitair Medisch Centrum Groningen, Groningen, GR, Netherlands

Jasper Stevens, PhD

• Touw, Daniel J., Universitair Medisch Centrum Groningen, Groningen, GR, Netherlands

Daniel J. Touw, PharmD, PhD

• Heerspink, Hiddo Jan L., Universitair Medisch Centrum Groningen, Groningen, GR, Netherlands

Hiddo Jan L. Heerspink, PhD

• Cherney, David, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

David Cherney, MD, PhD

• Singh, Sunita K., University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Sunita K. Singh, MD, MS, MSc

Background

Cardiovascular & kidney protective mechanisms with 12 weeks of sodium-glucose cotransporter-2 (SGLT2) inhibitor (dapagliflozin 10 mg daily) were assessed in kidney transplant recipients (KTR) with & without diabetes.

Methods

This randomized double-blind, parallel-group, placebo-controlled study enrolled 52 KTR & comprised three sequential physiologic assessments under clamped euglycemia: baseline, at 1 week & 12 weeks of treatment. The primary objective was to evaluate blood pressure (BP) lowering with dapagliflozin in KTR. Secondary outcomes were: iohexol-measured glomerular filtration rate (GFR), natriuresis, body composition, cardiac output monitoring, arterial stiffness, heart rate variability, neurohormones & safety.

Results

51 KTR completed the study – mean age 53.2 years, 62% with hypertension, 57% with T2D, 50% on RAS inhibitors & mean eGFR 68.2 mL/min/1.73m². Compared to placebo, dapagliflozin did not lower systolic BP at 1 or 12 weeks, though mean arterial pressure was reduced after 1 week (-3.9±1.8 mmHg, p=0.04). Dapagliflozin led to significant, placebo-adjusted reductions in iohexol-measured GFR from baseline to 1 week (4.2±1.5 ml/min/1.73m²) & 12 weeks (3.48±1.41 ml/min/1.73m²). Dapagliflozin significantly increased glucosuria without altering sodium handling. Dapagliflozin acutely decreased arterial stiffness (carotid augmentation index -3.55±1.24%, p_{within group}=0.006) & decreased sympathetic activation (dopamine p_{within group}=0.03 & heart rate variability p_{within group}=0.04) after 12 weeks. Dapagliflozin was safe & well tolerated.

Conclusion

Dapagliflozin activates mechanisms associated with cardiovascular & kidney protection in KTR.

Funding

• Commercial Support – AstraZeneca

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025p2pwyxyx