Abstract: FR-PO1204
Effects of SGLT2 Inhibitors on Change in Glomerular Filtration Rate in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis
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
- Lessa, Caio Toscano, Universidade de Brasilia, Brasília, DF, Brazil
- Bentes, Joao Victor Cardoso, Universidade Federal de Roraima, Boa Vista, RR, Brazil
- Arslan, Felemez, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
Background
SGLT2 inhibitors are indicated for chronic kidney disease, but kidney transplant recipients (KTRs) were largely excluded from major trials due to safety concerns. Whether SGLT2i preserve renal function beyond the initial acute glomerular filtration rate (GFR/eGFR) dip remains uncertain. We therefore conducted a systematic review and meta-analysis to evaluate the effect of SGLT2i on GFR/eGFR mean change from baseline in KTRs at 12 weeks or beyond.
Methods
We systematically searched PubMed, EMBASE, and Cochrane CENTRAL databases for RCTs that compared SGLT2i to placebo or standard of care in KTRs, without date or language restrictions. The final search date was May 2, 2026. Two independent reviewers screened and selected studies. Statistical analyses were conducted using RevMan 5.4. A random effects model was used and continuous outcomes were reported as mean difference (MD) with 95% confidence intervals (95% CI). Heterogeneity was assessed with the I2 statistic. The primary estimand was the between-group mean difference in change from baseline in GFR/eGFR.
Results
Out of 1,413 records retrieved by the search, three RCTs were included, enrolling 179 randomized participants; 164 participants contributed data to the primary GFR/eGFR analysis. Compared with placebo or standard care, SGLT2i were associated with a greater mean reduction from baseline in GFR/eGFR at final follow-up ≥12 weeks (MD: −2.73 mL/min/1.73 m2, 95% CI: −4.57 to −0.89; P = 0.004; I2 = 0%), with no statistical heterogeneity detected. In two studies the SGLT2i of choice was dapagliflozin 10 mg, while in the third trial it was empagliflozin 10 mg. The intervention periods were 12, 24 and 38 weeks. Genitourinary events were uncommon, though definitive safety inferences are limited by small sample sizes and short follow-up.
Conclusion
Available randomized evidence suggests that SGLT2i are associated with a small short-to-medium-term reduction in glomerular filtration measures in KTRs, possibly consistent with a hemodynamic filtration dip rather than proven graft injury. Larger, long-term blinded trials are needed to determine if the cardiorenal benefits established in non-transplant populations extend to KTRs.