SGLT2 Inhibitors in Kidney Transplant Recipients: A Pharmacist-Led Clinic in a Predominantly Hispanic and American Indian Population

Background: SGLT2 inhibitors have been shown to help modify disease progression for diabetes and CKD. Kidney transplant recipients (KTRs) were excluded from major RCTs utilizing these drugs. Here we describe kidney outcomes and adverse events among KT recipients in New Mexico (NM). Methods: This is a single-center retrospective chart review of KTRs in NM who were started on SGLT2 inhibitors from May 2019 through June 2023, and followed for one year after initiation of therapy. Diabetes management was done primarily by a clinician pharmacist-run clinic. The primary objective reviewed adverse events in immunocompromised people and the secondary objectives reviewed eGFR, proteinuria, HCT, and HgA1C. Results: We included 49 KTRs in this cohort, 24% American Indian, 16.3% non-Hispanic White, 46.9% Hispanic White, 4% Asian, 2% Black, 2% Native Hawaiian, and 4.8% unreported. 81.6% of patients were started on Empagliflozin, with 84.8% started on SGLT2 inhibitors for diabetes management and 27.1% for other causes. In one year 8.9% of patients had a urinary tract infection (UTI), with 4% having two UTIs and one requiring IV antibiotics to treat the UTI twice. One patient had a metatarsal amputation and the SGLT2 inhibitor was discontinued. Only 6% of patients were taken off the medications due to either adverse events or other reasons. No patients experienced ketoacidosis or a thrombotic event such as DVT. After adjusting for age, gender, and ethnicity there was a reduction of UACR (6mg/g per month) and UPCR (15 mg/g) per month of therapy. At 12 months there was an estimated 35% reduction in proteinuria with no significant change in the eGFR or HCT. Conclusion: SGLT2 inhibitors are a safe therapy among immunocompromised transplant recipients. A few patients in our study were taken off therapy due to an adverse event. The reduction in proteinuria was similar to what was seen in major RCTs. Using an interdisciplinary approach with the help of clinical pharmacists, quality of care delivered is greatly improved in this vulnerable population of patients who require comprehensive care due to their multiple comorbidities. - EGFR HCT UPCR Change in the lab per month of therapy 0.15 +/- 0.16 ml/min/1.73m2/month 0.08 +/- 0.18 %/month -14.6 +/- 5.8 mg/mg/month P Value 0.38 0.66 0.0127