The impact of sodium-glucose cotransporter-2 inhibitors on dialysis risk and mortality in kidney transplant patients with diabetes

Fu-Shun Yen; Chih-Cheng Hsu; Yun-Kai Yeh; Wan-Yin Cheng; Pei-Lun Liao; Chii-Min Hwu; James Cheng-Chung Wei

doi:10.1016/j.ajt.2025.03.019

The impact of sodium-glucose cotransporter-2 inhibitors on dialysis risk and mortality in kidney transplant patients with diabetes

Am J Transplant. 2025 Mar 21:S1600-6135(25)00148-0. doi: 10.1016/j.ajt.2025.03.019. Online ahead of print.

Authors

Fu-Shun Yen¹, Chih-Cheng Hsu², Yun-Kai Yeh³, Wan-Yin Cheng³, Pei-Lun Liao⁴, Chii-Min Hwu⁵, James Cheng-Chung Wei⁶

Affiliations

¹ Dr Yen's Clinic, Gueishan, Taoyuan, Taiwan.
² Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Huwei Township, Yunlin County, Taiwan.
³ Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Beitou District, Taipei, Taiwan.
⁴ Institute of Medicine, Chung Shan Medical University, South District, Taichung, Taiwan; Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁵ Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Beitou District, Taipei, Taiwan; Department of Medicine, National Yang-Ming Chiao Tung University School of Medicine, Taipei, Taiwan. Electronic address: chhwu@vghtpe.gov.tw.
⁶ Institute of Medicine, Chung Shan Medical University, South District, Taichung, Taiwan; Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, South District, Taichung City, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan. Electronic address: jccwei@gmail.com.

PMID: 40120646
DOI: 10.1016/j.ajt.2025.03.019

Abstract

Kidney transplantation is the optimal treatment for end-stage kidney disease, but many patients also have diabetes mellitus. This study compares long-term outcomes between new users of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) in kidney transplant recipients with diabetes mellitus. Data from the TriNetX Collaborative Network, including 89,710 patients with diabetes mellitus who underwent kidney transplantation between January 1, 2015, and June 30, 2023, were analyzed. From this cohort, 1410 matched pairs of SGLT2i and DPP-4i users were selected based on propensity scores. The results showed that SGLT2i users had a lower risk of dialysis (hazards ratio: 0.694) and all-cause mortality (hazards ratio: 0.687) compared with DPP-4i users. There were no significant differences in the risk of posttransplant infections, transplant rejection, or hospitalization between the 2 groups. Additionally, SGLT2i users had significantly lower cumulative incidences of dialysis and mortality. In conclusion, this study, using data from TriNetX, demonstrated that SGLT2i treatment in kidney transplant recipients with diabetes mellitus is associated with lower risks of dialysis and mortality, suggesting it may help preserve kidney function and improve survival in this population.

Keywords: all-cause mortality; diabetes mellitus; dialysis; graft failure; kidney transplantation.