Sodium-Glucose Cotransporter 2 Inhibitors in Diabetic Kidney Transplant Recipients: Impact on Glycemic Control, Graft Function, and Proteinuria

Matheus Rizzato Rossi; Leticia Harumi Richter Kawai; Marilda Mazzali; Marcos Vinícius de Sousa

Autores

Matheus Rizzato Rossi Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Divisão de Nefrologia – Campinas (SP) – Brasil. https://orcid.org/0000-0003-4597-4266
Leticia Harumi Richter Kawai Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Divisão de Nefrologia – Campinas (SP) – Brasil. https://orcid.org/0009-0004-3158-8334
Marilda Mazzali Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Divisão de Nefrologia – Campinas (SP) – Brasil. https://orcid.org/0000-0001-6297-4909
Marcos Vinícius de Sousa Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Divisão de Nefrologia – Campinas (SP) – Brasil. https://orcid.org/0000-0002-0280-1069

Palavras-chave:

Proteínas Transportadoras de Sódio-Glicose, Diabetes Mellitus, Transplante Renal, Agentes Imunossupressores, Sobrevivência do Enxerto

Resumo

Introdução: Os inibidores do cotransportador sódio-glicose 2 [sodium-glucose cotransporter 2 inhibitors (SGLT2i)] melhoram a albuminúria, a taxa de progressão da doença renal crônica e a morte cardiovascular em pacientes não transplantados com diabetes mellitus (DM) e proteinúria. No entanto, os receptores de transplante renal (RTRs) foram excluídos dos ensaios mais abrangentes. Este estudo teve como objetivo avaliar a função do enxerto, a proteinúria e o controle glicêmico em RTRs com DM pré- e pós-transplante tratados com SGLT2i. Métodos: Este é um estudo unicêntrico, retrospectivo e observacional, incluindo receptores de transplante com mais de 18 anos de idade no momento do transplante, diagnosticados com DM tipo 2 pré-transplante ou DM pós-transplante, tratados com SGLT2i após o transplante de junho de 2020 a junho de 2024. Resultados: Dos 1.883 RTRs acompanhados no centro de junho de 2020 a junho de 2024, 31 receberam SGLT2i, sendo 14 (45,2%) com DM pré-transplante e 17 (54,8%) com DM pós-transplante. Catorze (45,2%) completaram o acompanhamento de 24 meses, incluindo oito (57,1%) no grupo DM pré-transplante e seis (42,8%) no grupo DM pós-transplante. No grupo DM pré-transplante, a glicemia de jejum (GJ) [134 (92-295) mg/dL vs. 109 (73-207), p = 0,24], a taxa de filtração glomerular estimada (TFGe) [59,3 ± 19,2 vs. 68,1 ± 23,4, p = 0,35] e a relação proteína-creatinina na urina (RPCU) [0,3 (0,0-1,9) vs. 0,3 (0,1-0,7), p = 0,80] permaneceram estáveis. No grupo DM pós-transplante, também não houve diferença nos aspectos analisados, seja na GJ [113 (95-225) mg/dL vs. 108 (92-149), p = 0,38], TFGe [73,1 ± 26,8 vs. 69,1 ± 28,9, p = 0,76] ou RPCU [0,2 (0,1-2,5) vs. 0,2 (0,1-0,4), p = 0,21]. Conclusões: Estes resultados sugerem que o tratamento tem efeito benéfico na preservação da função do enxerto ao longo de um período de acompanhamento de 2 anos. O tratamento foi bem tolerado, com baixa incidência de infecção do trato urinário ou disfunção do enxerto.

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