Table 1:
Main studies reporting outcomes of SGLT2is on KTRs
| Study | Design | Population | Intervention | Results |
|---|---|---|---|---|
| Halden et al. 2019 [6] | RCT, n = 49 (22 patients on empagliflozin) | PTDM with KT >1 year, eGFR >30 ml/min/1.73 m2 | Empagliflozin versus placebo | Empagliflozin: |
| • Greater reduction of HbA1c: −0.2% (95% CI −0.6 to −0.1) versus 0.1% (95% CI −0.1–0.4) | ||||
| • Greater reduction in body weight: −2.5 kg (95% CI −4.0 to −0.05) versus 1.0 kg (95% CI 0.0−2.0) | ||||
| • No changes in BP or eGFR | ||||
| • No relevant pharmacokinetic interactions with immunosuppressive drugs | ||||
| • One case of urosepsis and one yeast infection | ||||
| Rajasekeran et al. 2017 [10] | Case series (4 SPKT, 6 KT) | KT or SPKT on canagliflozin | Canagliflozin | • No UTI or mycotic infections |
| • No episodes of AKI | ||||
| • Improvement in glycaemic control [HbA1c mean change −0.84% (SD 1.2)], weight [−2.14 kg (SD 2.8)] and BP [PAS −6.4 (SD 10.8)] | ||||
| AlKindi et al. 2020 [9] | Case series (8 KT) | KT on SGLT2i (T2DM or PTDM) | Empagliflozin (6 patients) and dapagliflozin (2 patients) | At 12 months: |
| • Reduction in HbA1c from 9.34% (SD 1.36) to 7.41% (SD 1.44) at 12 months | ||||
| • No significant changes in eGFR | ||||
| • No significant change in BP | ||||
| • Weight reduction from 84.8 kg (SD 12.8) to 82.8 kg (SD 11.4) at 6 months | ||||
| • One episode of UTI, no fungal infections | ||||
| Attallah and Yassine 2019 [13] | Case series (8 KT) | KT on empagliflozin (T2DM or PTDM) | Empagliflozin | At 12 months: |
| • HbA1c decrease of 0.85 g/dl | ||||
| • Slight decrease in eGFR, then stabilized | ||||
| • UPCR decrease of 0.6 g/day | ||||
| • Weight decrease of 2.4 kg | ||||
| • Two cases of UTI (one patient discontinued SGLT2i because of UTIs) | ||||
| Schwaiger et al. 2019 [7] | Prospective interventional study (14 KT) | Stable KT with insulin | Empagliflozin | At 12 months: |
| • No decrease in HbA1c. Improvement in beta-cell glucose sensitivity | ||||
| • Body weight decrease of 1.6 kg | ||||
| • At 4 weeks, a decrease in eGFR from 55.6 ml/min/1.73 m2 (SD 20.3) to 47.5 ml/min/1.73 m2 (SD 15.1). No change in UACR | ||||
| • During first 4 weeks: three UTI and one uncomplicated balanitis | ||||
| Mahling et al. 2019 [14] | Prospective case series (10 KT) | Stable KT | Empagliflozin | At 12 months: |
| • Stable eGFR | ||||
| • Median HbA1c 7.3–7.1% | ||||
| • Decrease in body weight −1.9 kg | ||||
| • Low rate of UTI and other side effects | ||||
| Shah et al. 2019 [15] | Prospective descriptive study (24 KT) | Stable KT with T2DM or PTDM, minimum follow-up 6 months | Canagliflozin | At 6 months: |
| • Weight reduction 78.6 kg (SD 12.1) to 76.1 kg (SD 11.2) | ||||
| • PAS from 142 (21) to 134 (SD 17) and PAD 81 (SD 9) to 79 (SD 8) | ||||
| • No significant change in creatinine | ||||
| • HbA1c 8.5% (SD 1.5) to 7.6% (SD 1) | ||||
| • No increase in infections | ||||
| Song et al. 2020 [16] | Observational retrospective (50 KT) | KT, eGFR >30 ml/min/1.73 m2 with T2DM or PTDM | Empagliflozin (n = 43), canagliflozin (n = 6) or dapagliflozin (n = 1) | At 6 months: |
| • Weight reduction of −2.95 kg (SD 3.54) | ||||
| • 14% of patients had a UTI (similar to the rate reported in KTRs) | ||||
| • No significant changes in renal function | ||||
| • Therapy discontinued in nine patients | ||||
| Lim et al. 2022 [8] | Observational retrospective (226 KT) | KT with T2DM on SGLT2i | • Mean follow-up 69.2 months (SD 42.2) | |
| SGLT2 group had: | ||||
| • Lower risk of primary composite outcome (all-cause mortality, death-censored graft failure and serum creatinine doubling) | ||||
| • Initial eGFR dip after initiation in 15.6% of KTRs, but eGFR recovered thereafter and remained stable | ||||
| Lemke et al. 2022 [17] | Observational retrospective (39 KT) | KT on SGLT2i (T2DM or PTDM) | Canagliflozin (n = 12), dapagliflozin (n = 3), empagliflozin (n = 24) | At 12 months: |
| • No significant change in kidney function | ||||
| • 25% of patients experienced an adverse event, with UTI the most common | ||||
| • HbA1c decline from a median of 8.4% (IQR 7.8–9.2) to 7.5% (6.8–8.0) | ||||
| • 17 patients (43%) discontinued the drug. The most common reasons were the cost of the drug and kidney function decline |
IQR: interquartile range; PAD: diastolic blood pressure; PAS: systolic blood pressure; SPKT: simultaneous pancreas–kidney transplantation; UACR: urinary albumin:creatinine ratio.