부산대학교 도서관

Background. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have cardioprotective and renoprotective effects. However, experience with SGLT2is in diabetic kidney transplant recipients (DKTRs) is limited. Methods. This observational multicentre study was designed to examine the efficacy and safety of SGLT2is in DKTRs. The primary outcome was adverse effects within 6 months of SGLT2i treatment. Results. Among 339 treated DKTRs, adverse effects were recorded in 26%, the most frequent (14%) being urinary tract infection (UTI). In 10%, SGLT2is were suspended mostly because of UTI. Risk factors for developing a UTI were a prior episode of UTI in the 6 months leading up to SGLT2i use {odds ratio [OR] 7.90 [confidence interval (CI) 3.63-17.21]} and female sex [OR 2.46 (CI 1.19-5.03)]. In a post hoc subgroup analysis, the incidence of UTI emerged as similar in DKTRs treated with SGLT2i for 12 months versus non-DKTRs (17.9% versus 16.7%). Between baseline and 6 months, significant reductions were observed in body weight [-2.22 kg (95% CI -2.79 to -1.65)], blood pressure, fasting glycaemia, haemoglobin Ale [-0.36% (95% CI -0.51 to -0.21)], serum uric acid [-0.44 mg/dl (95% CI -0.60 to -0.28)] and urinary proteinxreatinine ratio, while serum magnesium [+0.15 mg/dl (95% CI 0.11-0.18)] and haemoglobin levels rose [+0.44 g/dl (95% CI 0.28-0.58]. These outcomes persisted in participants followed over 12 months of treatment. Conclusions. SGLT2is in kidney transplant offer benefits in terms of controlling glycaemia, weight, blood pressure, anaemia, proteinuria and serum uric acid and magnesium. UTI was the most frequent adverse effect. According to our findings, these agents should be prescribed with caution in female DKTRs and those with a history of UTI. Experience with sodium-glucose cotransporter-2 inhibitor (SGLT2i) treatment in diabetic kidney transplant recipients (DKTRs) is limited, as these agents may increase the risk of kidney graft dysfunction and urinary tract infection (UTI). Recently, however, these drugs have shown clear nephroprotective and cardioprotective effects in non-transplanted individuals with diabetes. The objective of this multicentre study was to describe our experience with SGLT2i treatment in DKTRs. Treatment was effective in controlling glycemia and had the additional benefits of improving weight, blood pressure, anaemia, proteinuria and serum levels of magnesium and uric acid. However, the frequency of UTI was greater than that reported for non-transplanted diabetic individuals. Previous UTIs and female sex were identified as risk factors for developing a UTI. The findings of this study suggest that as with non-transplanted diabetics, DKTRs will benefit from SGLT2i treatment, although female patients and those with a history of UTI need to be closely monitored. Keywords: post-transplant diabetes mellitus, SGLT2 inhibitors, type 2 diabetes
INTRODUCTION Diabetes mellitus (DM) is an important cause of end-stage renal disease worldwide [1], and this has led to a steady increase in diabetic individuals among kidney transplant recipients (KTRs) [...]