Use of SGLT2i after kidney transplantation, first experiences

Recent large randomized trials have demonstrated the benefit of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in improving renal and CV outcomes in patients (pc) with chronic kidney disease. According to the new KDIGO guidelines, SGLT2i are the first choice of treatment for diabetics with chronic kidney disease (CKD), but also for other pc with CKD and pc with heart failure with or without diabetes (DM). However, there is insufficient data on the efficacy and safety of SGLT2i administration in pc after renal transplantation (KTP) with or without DM, since, due to safety concerns, these PC were not included in randomized studies that resulted in the clinical use of this group of drugs in CKD PC. Currently, there are limited literature data, mostly related to the short-term efficacy and safety results of SGLT2i administration in KTP. For now, there is a lack of data related to the long-term outcomes of kidney graft survival and the frequency of CV complications in these PCs. In the paper, we analyzed 15 PCs who underwent kidney transplantation (KT) in our institution and who were administered SGLT2i. The drug was administered at an interval of 1 month to 5 years, and was introduced in a period of 8 months to 10 years after CT. The reasons for the administration of the drug were chronic graft dysfunction with or without proteinuria. The frequency of side effects was not high. We draw attention to the necessity of greater clinical caution when applying SGLT2i in KTP in conditions of general condition disturbances, possible dehydration and/or hypotension, such as various febrile conditions, vomiting and diarrheal syndrome, where the possibility of acute graft dysfunction and symptoms of drug intolerance can easily and quickly occur.