In patients with chronic kidney disease (CKD) and diabetes, sodium-glucose cotransporter 2 inhibitors (SGLT2i) may be more effective in slowing disease progression than dipeptidyl peptidase 4 inhibitors (DPP4i), according to new study findings presented at Kidney Week 2021, the virtual meeting of the American Society of Nephrology. Other research demonstrates that SGLT2i may help preserve graft function in kidney transplant recipients (KTRs) with diabetes.

Of 64,564 veterans (96% male; mean age 68 years) with diabetes in the 2004-2018 VA Health Care System, 10,861 progressed to end-stage kidney disease (ESKD) and/or died. Compared with DPP4i users, SGLT2i users had a significant 14% lower risk for the composite outcome of ESKD or death. Only patients with pre-existing CKD, who comprised 51% of the cohort, experienced this benefit, Connie Rhee, MD, MSc, of the University of California Irvine, and colleagues reported. Glucagon-like peptide 1 receptor agonists (GLP1a) showed comparable risk to DPP4i.

The second study included 2083 Korean KTRs with diabetes, of whom 226 (10.8%) were treated with SGLT2i. Over a mean follow-up period of 63 months, SGLT2i users had a significant 48% and 54% lower risk of the primary composite outcome (all-cause mortality, death-censored graft failure, and serum creatinine doubling) compared with SGLT2i nonusers, in the multivariate and propensity score-matched models, respectively. SGLT2i appeared to be most protective against serum creatinine doubling, Jang-Hee Cho, MD, of Kyungpook National University School of Medicine in Daegu, Korea, pointed out.


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Some SGLT2i users (15.6%) experienced an acute dip in estimated glomerular filtration rate (eGFR) of more than 10% during the first month, but the eGFR subsequently recovered. The risk factors for the eGFR dip were shorter time from transplantation to SGLT2i initiation and a high mean tacrolimus trough level.

“SGLT2 inhibitors have renoprotective effects and can be used safely in diabetic kidney transplant recipients,” Dr Cho told Renal & Urology News. “However, nephrologists should monitor kidney function to observe the initial eGFR decline, especially in the early post-transplant period and in patients with high tacrolimus levels.”

References

Narasaki Y, Kovesdy CP, You AS, et al. Comparative effectiveness of SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 agonists in US veterans with and without CKD. Presented at: Kidney Week 2021; November 2-7, 2021. Poster: PO0750.

Lim JH, Kwon S, Noh HW, et al. Sodium-glucose cotransporter 2 inhibitors in kidney transplant recipients. Presented at: Kidney Week 2021; November 2-7, 2021. Abstract: TH-OR55.