Effectiveness and safety of SGLT-2 inhibitors for renal allograft recipients with post-transplant diabetes mellitus: an open single-center prospective study

Objective. evaluation of the safety and efficacy of therapy with sodium glucose cotransporter 2 (SGLT-2) inhibitors in kidney transplant (kt) recipients with post-transplantation diabetes mellitus (PTDM). material and methods. an open single-center prospective study of the use of sglt-2 inhibitors (canagliflozin 300 mg/day or empagliflozin 25 mg/day or dapagliflozin io mg/day) and other hypoglycemic agents (metformin, insulin, sulfonylurea, glinides, and dipeptidyl peptidase-4 inhibitors) in various combinations for 24 weeks included 57 kt recipients who underwent transplantation more than a year ago, with a diagnosis of PTDM, with stable kidney function (estimated glomerular filtration rate - egfr > 30 ml/min/1.73 m2) against the background of immunosuppressive therapy. patients were divided into groups: the first (experimental) - 12 individuals (11 men) who received sglt-2 inhibitors in combination with other hypoglycemic drugs, and the second (control) - 45 individuals (23 men) on standard hypoglycemic therapy without sglt-2 inhibitors. results. 57 kt recipients (12 on sglt-2 inhibitors and 45 on standard hypoglycemic therapy; 33 men) completed the study. 24 weeks after the start of therapy with sglt-2 inhibitors, statistically significant differences in the first (experimental) group compared with the second (control) were obtained in relation to: glycemic control- Δ% fasting plasma glucose -2.34 vs 8.38; Δp=0.047, Δ% hbaic -2.02 versus -0.89; Δp=0.022; anthropometric indicators - Δ% body weight -6.42 versus -1.9; P=0.001, Δ% bmi -5.25 vs. 0.36; p=0.002; hemodynamics - Δ% sbp -2.31 versus 0.00; p=0.000. according to metabolic parameters, a significant change in Δ% uric acid was noted - -23.61 versus -2.86; p=0.041;according to hematological parameters, Δ% erythrocytes was 9.47 versus 2.05; P=0.041. there were no statistically significant differences between the experimental and control groups in terms of renal allograft function: Δ% egfr - 9.65 versus - 10.53; p=0.083, Δ% mau 0.00 versus 0.00; p=0.248. there was no difference in immunosuppressive therapy: the minimum concentration of CALCINEURIN inhibitors (Co) Δ% CYCLOSOPRINE 0.00 vs -6.15; P=0.826, Δ% tacrolimus 7.14 vs 0.00; p=0.317. the frequency of side effects did not differ: cases of urinary infection 1/11 (9%) vs. 3/42 (7.1%); P>0.05. Conclusion. sglt-2 inhibitors in combination with other antihyperglycemic agents safely improve anthropometric and metabolic parameters in pt recipients with ptdm compared with standard dm therapy without sglt-2 inhibitors. an increase in the erythrocyte level in the first group was noted.

post-transplant diabetes mellitus, sodium-glucose cotransporter 2 inhibitors, renal allograft, calcineurin inhibitors