Kidney Week

Abstract: SA-PO1073

The Efficacy and Safety of SGLT2 Inhibitors and GLP1 Receptor Agonists in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - II
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Sridhar, Vikas, University Health Network, Toronto, Ontario, Canada

Vikas Sridhar,

• Zelderloo, Maïté, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium

Maïté Zelderloo,

• Li, Yanhong, University Health Network, Toronto, Ontario, Canada

Yanhong Li,

• Cherney, David, University Health Network, Toronto, Ontario, Canada

David Cherney,

• Singh, Sunita K., University Health Network, Toronto, Ontario, Canada

Sunita K. Singh,

Background

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) decrease adverse cardiorenal outcomes in the general population. We aimed to evaluate the efficacy and safety of SGLT2i and GLP1RA monotherapy and combination therapy in kidney transplant recipients (KTR).

Methods

This was a retrospective cohort study of all adult KTR started on SGLT2i and/or GLP1RA between January 1, 2000 and December 31, 2021. Baseline characteristics, drug safety/tolerability, estimated glomerular filtration rate (eGFR), and cardiorenal outcomes were collected.

Results

Of 227 patients analyzed, 78 were on SGLT2i, 79 on GLP1RA and 70 on combination therapy. 120 patients had pretransplant diabetes (DM) (53.6%) and 103 had post-transplant DM (46.0%). Compared to the period before drug initiation, there were no differences in rates of CV events and graft failure with either monotherapy or combination therapy. After one month, SGLT2 inhibition resulted in a median eGFR decline of 6 ml/min/1.73m² (interquartile range -11 to 3.5) (Figure 1). Drug discontinuation was high, with 19.2% of SGLT2i users, 28.7% of GLP1RA and 41.4% on combination therapy stopping therapy – ‘hospitalization’ with SGLT2i and ‘intolerance’ with GLP1RA and combination therapy were the most frequent causes of discontinuation. However, compared to the period before drug initiation, rates of urinary tract infections, ketoacidosis, acute kidney injury and hepato-pancreato-biliary complications were not significantly different.

Conclusion

SGLT2i, GLP-1RA and combination therapy appear to be safe in KTR, though drug discontinuation is relatively common. The acute eGFR ‘dip’ observed with SGLT2 inhibition suggests tubular-glomerular mechanisms are intact in this unique population.