P129 - ECE_2172 - SGLT2 inhibitors and cardiovascular effects in kidney transplant recipients with diabetes mellitus
TL;DR
SGLT2i use was associated with a lower risk of major cardiovascular events in KTRs with diabetes, consistent with benefits observed in non-transplant populations, and support further investigation of SGLT2i therapy in this population.
Abstract
SGLT2 inhibitors (SGLT2i) reduce major adverse cardiovascular events and mortality in patients with type 2 diabetes mellitus (T2DM), but kidney transplant recipients (KTRs), a high-risk group, were excluded from major trials. We aimed to evaluate the cardiovascular effects of SGLT2i in KTRs with diabetes. In this retrospective matched-cohort study at a large transplant center, KTRs with diabetes treated with SGLT2i were compared to matched controls receiving other antihyperglycemic agents. Major outcomes were: (1) a composite of acute coronary syndrome (ACS), stroke/transient ischemic attack (TIA), or all-cause mortality; and (2) a composite of heart failure hospitalizations or all-cause mortality. A total of 480 patients (240 per group; 20% women; median age 63-64 years) were followed for up to three years. The incidence of ACS, stroke/TIA, or death was 7.9 vs 13.6 events per 100 person-years in the SGLT2i and control groups, respectively (adjusted HR 0.64, 95% CI 0.42-0.97, P = .039). Heart failure hospitalizations or death occurred less frequently in SGLT2i users (5.7 vs 11.6 events per 100 person-years), though the difference was not statistically significant after adjustment (HR 0.82, 95% CI 0.50-1.32, P = .410). SGLT2i use was associated with a lower risk of major cardiovascular events in KTRs with diabetes, consistent with benefits observed in non-transplant populations. Given the elevated cardiovascular risk in KTRs, these findings support further investigation of SGLT2i therapy in this population.