Administration of sodium-glucose cotransporter-2 inhibitors in kidney transplant patients with diabetes: a systematic review and meta-analysis

Hamidreza Khodabandeh; Zahra Bakhshizade; Mohammad Hossein Taklif; Halime Zaeri Fakhrabadi; Soleyman Alivand; Noorbakhsh Alivand; Ghazaleh Rashidizadeh; Leila Jampour; Mahsa Shirani

doi:10.34172/jnp.2023.21477

J Nephropathol. 2023;12(4): e21477.
doi: 10.34172/jnp.2023.21477

Scopus ID: 85172673483

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Meta-analysis

Administration of sodium-glucose cotransporter-2 inhibitors in kidney transplant patients with diabetes: a systematic review and meta-analysis

Hamidreza Khodabandeh ¹ , Zahra Bakhshizade ² , Mohammad Hossein Taklif ² , Halime Zaeri Fakhrabadi ³ , Soleyman Alivand ⁴ , Noorbakhsh Alivand ⁵ , Ghazaleh Rashidizadeh ⁶ , Leila Jampour ⁶ , Mahsa Shirani ⁷^*

¹ Department of Radiology, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
² Department of Nursing, Student Research Committee, Faculty of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
³ Department of Health Management and Economics, School of Health, Tehran University of Medical Sciences, Tehran, Iran
⁴ Department of Biostatistical and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
⁵ Department of Nutrition, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
⁶ Department of Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
⁷ Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran

*Corresponding Author: Mahsa Shirani, Email: Shiranimahsa95@gmail.com

Abstract

Introduction: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a new diabetes treatment. Considering the prescription of these medicines for kidney transplant patients, this systematic review and meta-analysis aimed to investigate the impact of SGLT2 inhibitors on kidney transplant patients.

Material and Methods: This meta-analysis study was performed based on the PRISMA guideline. The necessary data were collected by searching the databases of Scopus, PubMed, Cochrane, Google Scholar search engine, and Web of Science without a time limit until March 1, 2023. The data were analyzed in STATA 14. A P value less than 0.05 was considered significant.

Results: The authors assessed eight articles with a sample size of 960 patients. The SGLT2 inhibitors showed no significant impact on levels of estimated glomerular filtration rate [SMD: -0.21 (95% CI: -0.65, 0.25)], serum creatinine [SMD: -0.02 (95% CI: -0.19, 0.15)], plasma hemoglobin A1c (HbA1c) [SMD: -0.62 (95% CI: -1.43, 0.18)], systolic blood pressure [SMD: -0.64 (95% CI: -1.80, 0.52)], and diastolic blood pressure [SMD: -0.64 (95% CI: -1.41, 0.14)], and on the patient’s weight [SMD:-0.31 (95% CI: -0.80, 0.18)]. Patient age did not influence the impact of SGLT2 inhibitors on estimated glomerular filtration rate (50–59 years-old age group: [SMD: 0.13 (95% CI: -0.04, 0.30)], 60–69 years-old age group: [SMD: -0.56 (95 % CI: -1.38, 0.26]). Duration of medicine use did not affect the impact of SGLT2 inhibitors on estimated glomerular filtration rate [6 months after medicine use: SMD: -0.56 (95% CI: -1.38, 0.26)], 12 months after medicine use: [SMD: 0.10 (95% CI: -0.05, 0.26)].

Conclusion: SGLT2 inhibitors were not effective in lowering blood pressure, estimated glomerular filtration rate, serum creatinine, and hemoglobin A1c levels, or weight in kidney transplant patients. Although SGLT2 inhibitors were ineffective in improving kidney transplant patients’ renal function, there were no side effects, and the administration of this drug in kidney transplant patients can continue. Further research is required to ensure safety and determine the appropriate dosage and duration of drug use.

Registration: The study was compiled according to the PRISMA checklist and its protocol was registered on the PROSPERO (ID: CRD42023407501) and Research Registry (UIN: reviewregistry1666) websites.

Keywords: Diabetes mellitus, Sodium-glucose cotransporter two protein, Human, SGLT2 protein, Dapagliflozin, Canagliflozin, Empagliflozin, Kidney transplantation, Renal transplantation

Implication for health policy/practice/research/medical education:

The administration of SGLT2 inhibitors did not significantly affect blood pressure and weight in kidney transplant patients. In addition, no significant change was observed in the levels of estimated glomerular filtration rate, serum creatinine, and HbA1c in patients at the end of the study compared with the baseline values. Considering the special conditions of kidney transplant patients and the risks associated with kidney transplantation, more clinical trials should be conducted before SGLT2 inhibitors are widely prescribed. These studies would give us a more complete view of the effects of SGLT2 inhibitors on these patients.

Please cite this paper as: Khodabandeh H, Bakhshizade Z, Taklif MH, Zaeri Fakhrabadi H, Alivand S, Alivand N, Rashidizadeh G, Jampour L, Shirani M. Administration of sodium-glucose cotransporter-2 inhibitors in kidney transplant patients with diabetes: a systematic review and meta-analysis. J Nephropathol. 2023;12(4):e21477. DOI: 10.34172/jnp.2023.21477.