Kidney Week

Abstract: FR-PO1205

Safety and Efficacy of SGLT2 Inhibitors in Kidney Transplant Recipients in the Saudi Population

Session Information

• Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Alanazi, Abdullah Mordhi, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Abdullah Mordhi Alanazi, MBBS

• Alqudsi, Muhannad, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Muhannad Alqudsi, MD

• Alotaibi, Khalid Ayidh, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Khalid Ayidh Alotaibi, MBBS

• Alghamdi, Hazim Safar, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Hazim Safar Alghamdi, MBBS

• Aldhilan, Abdulrahman, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Abdulrahman Aldhilan

• Alshammari, Saad Khalaf, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Saad Khalaf Alshammari, MBBS

• Alrasheed, Ahmed Saud, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Ahmed Saud Alrasheed, MBBS

Background

Sodium-glucose cotransporter-2 (SGLT2) inhibitors demonstrate renoprotective effects in patients with chronic kidney disease with or without diabetes mellitus (DM), yet their safety and efficacy in renal transplant recipients remain incompletely characterized especially in non-diabetic patients.

Methods

At King Abdulaziz Medical City, we retrospectively reviewed 2465 post kidney transplant patients between January 2015 - December 2024. 254 patients fulfilled inclusion criteria and were receiving dapagliflozin. Baseline and final creatinine, estimated glomerular filtration rate (eGFR), albuminuria, and wight, and dapagliflozin-associated adverse events were identified. Results were compared by DM status. Univariate and multivariate logistic regression identified predictors of urinary tract infection (UTI), pyelonephritis, and genitourinary infections. Generalized linear models were employed to identify predictors of final eGFR and urine albumin-to-creatinine ratio (UACR).

Results

Mean age was 58 ± (12) years, females were 61%, with median dapagliflozin treatment duration of 2± (1.0) years. Median UACR declined from 68 to 37 mg/g (p<0.001), eGFR increased from 71 to 76 ml/min (p<0.001), and weight decreased from 79.9 to 77.7 Kg (p<0.001). In multivariate analysis, baseline post-transplant duration independently predicted final eGFR and UACR (Beta coefficients = −0.635 per year, p=0.001, and adjusted mean ration=1.034 respectively). Occurrence of diabetic ketoacidosis was 0.8%, acute kidney injury was 5.1%, urinary infections was 15.0% with male gender (adjusted odds ratio 0.30, 95% CI 0.14–0.63, p=0.001) protective against UTI, hyperkalemia was 11.4%, hypoglycemia was 5.9%, and lower limb ulceration was 2%. There was no difference in side effects occurrence by DM status.

Conclusion

Dapagliflozin demonstrates favorable effects on albuminuria in renal transplant recipients with an acceptable safety profile regardless of DM status. However, urinary infections emerge as the most frequent adverse events predominantly in female. These findings support cautious integration of SGLT2 inhibitors into immunosuppressive regimen of renal transplant recipients with individualized risk-benefit assessment and close monitoring for infectious complications. More controlled trials are needed for better evaluation.