Recent clinical trials evidenced that sodium/glucose cotransporter 2 inhibitors (SGLT2i) delay the progression of diabetic kidney disease, mainly by the reduction of intraglomerular pressure. These renoprotective effects have not been investigated in diabetic kidney transplant(KT) patients.
We prospectively have followed diabetic KT patients treated with dapagliflozin(n=67), which was started at 42(median; 1-407) posttransplant months. Twenty-two patients had posttransplant DM and 4 had type 1 DM. Baseline serum creatinine was 1.2±0.4(0.6~2.5)mg/dl.
Urinary albumin-creatinine ratio at baseline was 118.9±231.0 mcg/mg, which significantly decreased to 82.7±152.1 at 6 months(p=0.003, paired t test) and to 36.1±137.3 at 12 months(p=0.109). Baseline HbA1c was 7.3±1.0%, which showed a decrease at 6(7.1±0.9%, p=0.004) and 12(7.1±1.0%, p=0.035) months. Body weight decreased significantly from 69.7±16.0 to 68.1±16.1 kg(p=0.000) at 6 months. Serum creatinine did not change significantly between baseline and 1 month, and also between baseline and 12 months. No patients developed acute graft dysfunction. Among the 24 patients on insulin, 9 patients could stop insulin. Office blood pressure also was not changed significantly but 19 of 49 patients on antihypertensive medication had a decrease in the number and/or dose of anti-hypertensive drugs. Eight patients stopped dapagliflozin, due to acute cystitis in 3, weight loss in 2, and patient's preference in 3.
SGLT2i reduces microalbuminuria in diabetic KT patients. Whether SGLT2i elicits a long-term favorable graft outcome remains to be determined by further studies.