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中华移植杂志(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 306 -312. doi: 10.3877/cma.j.issn.1674-3903.2026.04.015

综述

钠-葡萄糖共转运蛋白2抑制剂在肾移植合并糖尿病受者中的应用
梁寒婷1, 李想1, 孔晶1, 张喆楠2, 高孟涵1, 李一涵1, 郑超1, 王鸣2,†()   
  1. 1310009 杭州,浙江大学医学院附属第二医院内分泌科
    2310009 杭州,浙江大学医学院附属第二医院泌尿外科
  • 收稿日期:2025-12-29 出版日期:2026-08-25
  • 通信作者: 王鸣
  • 基金资助:
    国家自然科学基金(82370817); 浙江省自然科学基金(LQ23H07003); 浙江省医疗卫生科技规划项目(2023RC167)

Application of sodium-glucose co-transporter 2 inhibitors in kidney transplant recipients with diabetes

Hanting Liang1, Xiang Li1, Jing Kong1, Zhenan Zhang2, Menghan Gao1, Yihan Li1, Chao Zheng1, Ming Wang2,†()   

  1. 1Department of Endocrinology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
    2Department of Urology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
  • Received:2025-12-29 Published:2026-08-25
  • Corresponding author: Ming Wang
引用本文:

梁寒婷, 李想, 孔晶, 张喆楠, 高孟涵, 李一涵, 郑超, 王鸣. 钠-葡萄糖共转运蛋白2抑制剂在肾移植合并糖尿病受者中的应用[J/OL]. 中华移植杂志(电子版), 2026, 20(04): 306-312.

Hanting Liang, Xiang Li, Jing Kong, Zhenan Zhang, Menghan Gao, Yihan Li, Chao Zheng, Ming Wang. Application of sodium-glucose co-transporter 2 inhibitors in kidney transplant recipients with diabetes[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2026, 20(04): 306-312.

肾移植受者常合并糖尿病,若血糖控制不佳会影响近期和远期预后,其血糖管理需依赖降糖药物在内的综合治疗方案。钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)除降糖作用外,还具有保护心肾功能及改善代谢的作用,已广泛应用于普通糖尿病患者,但其应用于肾移植合并糖尿病这一特殊群体中的循证医学证据较为有限。本文综述SGLT2i作用机制、对肾移植合并糖尿病受者的获益与风险,以期提高临床医师对SGLT2i应用于肾移植合并糖尿病受者这一特殊群体的重视。

Kidney transplant recipients frequently experience comorbid diabetes mellitus. Suboptimal glycemic control adversely impacts both the short- and long-term prognosis of these patients, and glucose-lowering management strategies require comprehensive treatment including antidiabetic drugs. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), beyond the glucose-lowering efficacy, exhibit cardiac and renal protective effects as well as metabolic benefits, and are widely used in general patients with diabetes. However, evidence-based medical evidence supporting their use in the specific population of kidney transplant recipients with diabetes remains relatively limited. This review briefly summarizes the mechanisms of action of SGLT2i and their potential benefits and risks for kidney transplant recipients with diabetes, aiming to enhance clinicians′ awareness regarding the application of these agents in this unique patient group.

表1 SGLT2i应用于肾移植合并糖尿病受者的临床研究
作者 研究类型 研究设计 随访时间(月) 代谢结局 肾脏结局 心血管结局 不良反应
Lim等[21] 回顾性研究 SGLT2i:n=127;对照组:未使用SGLT2i(n=127) 56.3(44.1,70.3) NA NA 主要不良心血管事件↓↓
心肌梗死↓↓
UTI:SGLT2i组1.73例/百人年,对照组0.96例/百人年
Yeggalam等[22] 回顾性研究 SGLT2i:n=44;对照组:未使用SGLT2i(n=70) 12 HbA1c ↓
体重↓↓
TC →
TG →
LDL-C →
HDL-C →
Scr →
eGFR →
SBP →
DBP →
AKI 16%,UTI 11%,生殖系统真菌感染2%,DKA 2%,截肢2%
Sánchez Fructuoso等[23] 前瞻性研究 SGLT2i:Empa(n=193),Dapa(n=81),Cana(n=64),Ertu(n=1);对照组:无 12 HbA1c ↓↓
FPG ↓↓
体重↓↓
尿酸↓↓
eGFR →
ACR ↓↓
SBP ↓↓
DBP ↓↓
UTI 14%,蛋白尿4.7%,生殖系统霉菌感染1.5%,AKI 1.8%,低血糖1.2%,腹泻0.6%
Mahmoud等[24] 回顾性研究 SGLT2i:Cana(n=98);对照组:二甲双胍/磺脲类/DPP4抑制剂/胰岛素(n=70) 12 HbA1c ↓↓
BMI ↓↓
尿酸↓
eGFR →
ACR ↓↓
SBP ↓
DBP →
UTI 15.3%,生殖系统感染1%,心肌感染2%,心力衰竭1%,脑卒中1%
Demir等[25] 回顾性研究 SGLT2i:Empa、Dapa(n=36);对照组:未使用SGLT2i(n=21) 12 HbA1c ↓↓ Scr →
eGFR →
UPro ↓
NA UTI 16.67%
刘金瑞等[26] 前瞻性研究 SGLT2i:常规降糖方案+Dapa(n=25);对照组:常规降糖方案(n=23) 24 FPG ↓↓
HbA1c ↓↓
TC ↓↓
TG ↓↓
LDL-C →
Scr →
eGFR →
ACR ↓↓
NA UTI 4例,低血压1例,低血糖1例
Miyazaki等[27] 病例系列 SGLT2i:Empa 8~24 HbA1c ↓
体重↓
Scr →
eGFR →
SBP ↓
DBP ↓
未发现
Lim等[28] 回顾性研究 SGLT2i:Empa(n=150),Dapa(n=76);对照组:未使用SGLT2i(n=1 857) 62.9±42.2 NA 血清肌酐翻倍率:SGLT2i组低于对照组(P=0.009) NA UTI 4.5例/百人年
Lemke等[29] 回顾性研究 SGLT2i:Empa(n=24),Cana(n=12),Dapa(n=3);对照组:无 12 HbA1c ↓↓ Scr →
eGFR →
NA UTI 6例,糖尿病足溃疡2例,AKI 2例,DKA 1例,低血糖2例
Song等[30] 回顾性研究 SGLT2i:Empa(n=43),Cana(n=6),Dapa(n=1);对照组:无 6 HbA1c ↓
体重↓↓
eGFR → NA UTI 7例
Hisadome等[31] 回顾性研究 SGLT2i:n=26;对照组:未使用SGLT2i(n=59) 12 HbA1c →
体重↓↓
TC →
TG →
LDL-C →
HDL-C →
eGFR →
UP/UCr →
SBP →
DBP →
UTI 6.4%
AlKindi等[32] 病例系列 SGLT2i:Empa(n=6),Dapa(n=2) 12 HbA1c ↓↓
BMI ↓↓
Scr ↓
eGFR →
SBP ↓
DBP ↓
UTI 1例
Shah等[33] 前瞻性研究 SGLT2i:Cana(n=24);对照组:无 6 HbA1c ↓↓
体重↓↓
Scr →
肌酐清除率→
SBP ↓↓
DBP ↓
未发现
Schwaiger等[34] 前瞻性研究 SGLT2i:Empa(n=14);对照组:无 1~12 HbA1c ↑↑
体重↓↓
尿酸↓
Scr →
eGFR →
ACR →
SBP →
DBP ↓↓
UTI 3例,肺炎1例,龟头炎1例
Mahling等[35] 前瞻性研究 SGLT2i:Empa(n=10);对照组:无 12(5.3,12) HbA1c ↓
体重↓
尿酸↓
eGFR → SBP ↓
DBP →
UTI 2例,AKI 1例,下肢小溃疡1例
Halden等[36] 随机对照试验 SGLT2i:Empa(n=22);对照组:安慰剂(n=22) 6 HbA1c ↓↓
FPG ↓
体重↓↓
尿酸↓↓
eGFR → SBP →
DBP →
两组不良反应事件无显著差异:SGLT2-i组头晕2例,面部肿胀1例,生殖器真菌感染1例,外阴瘙痒1例,血尿1例,UTI 3例
Attallah等[37] 病例系列 SGLT2i:Empa 12 HbA1c ↓
体重↓
Scr →
UPro ↓
SBP ↓ UTI 2例,恶心2例
Rajasekeran等[38] 病例系列 SGLT2i:Cana 肾移植:(10.1±4.2)个月
胰肾联合移植:(5.6±3.4)个月
HbA1c ↓
体重↓
Scr →
eGFR →
SBP ↓
DBP ↓
蜂窝织炎1例,低血糖1例
1
Sridhar VS, Ambinathan JPN, Gillard P, et al. Cardiometabolic and kidney protection in kidney transplant recipients with diabetes: mechanisms, clinical applications, and summary of clinical trials[J]. Transplantation, 2022, 106(4): 734-748.
2
中国研究型医院学会糖尿病学专业委员会,中华医学会糖尿病学分会,北京医学会糖尿病学分会. 实体器官移植后糖尿病患者降糖药物应用专家共识(2024版)[J]. 中华内分泌外科杂志,2024, 18(2): 156-172.
3
Cowie MR, Fisher M. SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control[J]. Nat Rev Cardiol, 2020, 17(12): 761-772.
4
Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes[J]. N Engl J Med, 2019, 380(4): 347-357.
5
Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy[J]. N Engl J Med, 2019, 380(24): 2295-2306.
6
Buse JB, Wexler DJ, Tsapas A, et al. 2019 update to: management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)[J]. Diabetes Care, 2020, 43(2): 487-493.
7
Oliveras L, Montero N, Cruzado JM. Searching in the maze: sodium-glucose cotransporter-2 inhibitors in kidney transplant recipients to improve survival[J]. Clin Kidney J, 2023, 16(6): 909-913.
8
Kanbay M, Copur S, Topçu AU, et al. An update review of post-transplant diabetes mellitus: concept, risk factors, clinical implications and management[J]. Diabetes Obes Metab, 2024, 26(7): 2531-2545.
9
Ong SC, Rhee CM. Novel management of diabetes in kidney transplantation[J]. Curr Opin Nephrol Hypertens, 2021, 30(1): 5-13.
10
Penmatsa KR, Muthukumar T. Activating the flozin shield: cardioprotective effects of sodium-glucose cotransporter-2 inhibitors in kidney transplant recipients with diabetes mellitus[J]. Kidney Int Rep, 2024, 9(8): 2326-2328.
11
Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes[J]. N Engl J Med, 2015, 373(22): 2117-2128.
12
Wright EM, Loo DD, Hirayama BA. Biology of human sodium glucose transporters[J]. Physiol Rev, 2011, 91(2): 733-794.
13
Cherney DZ, Perkins BA, Soleymanlou N, et al. Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus[J]. Circulation, 2014, 129(5): 587-597.
14
Kogot-Levin A, Hinden L, Riahi Y, et al. Proximal tubule mTORC1 is a central player in the pathophysiology of diabetic nephropathy and its correction by SGLT2 inhibitors[J]. Cell Rep, 2020, 32(4): 107954.
15
Packer M. SGLT2 inhibitors produce cardiorenal benefits by promoting adaptive cellular reprogramming to induce a state of fasting mimicry: a paradigm shift in understanding their mechanism of action[J]. Diabetes Care, 2020, 43(3): 508-511.
16
Pippin JW, Kaverina NV, Eng DG, et al. Cells of renin lineage are adult pluripotent progenitors in experimental glomerular disease[J]. Am J Physiol Renal Physiol, 2015, 309(4): F341- F358.
17
Van der Pluijm LAK, Koudijs A, Stam W, et al. SGLT2 inhibition promotes glomerular repopulation by cells of renin lineage in experimental kidney disease[J]. Acta Physiol (Oxf), 2024, 240(3): e14108.
18
Yang W, Li X, He L, et al. Empagliflozin improves renal ischemia-reperfusion injury by reducing inflammation and enhancing mitochondrial fusion through AMPK-OPA1 pathway promotion[J]. Cell Mol Biol Lett, 2023, 28(1): 42.
19
Chen X, Hocher CF, Shen L, et al. Reno- and cardioprotective molecular mechanisms of SGLT2 inhibitors beyond glycemic control: from bedside to bench[J]. Am J Physiol Cell Physiol, 2023, 325(3): C661- C681.
20
Zhang J, Cai W, Liu D, et al. Effect of henagliflozin on aging biomarkers in patients with type 2 diabetes: a multicenter, randomized, double-blind, placebo-controlled study[J]. Cell Rep Med, 2025, 6(9): 102331.
21
Lim JH, Kwon S, Seo YJ, et al. Cardioprotective effect of SGLT2 inhibitor in diabetic kidney transplant recipients: a multicenter propensity score matched study [J]. Kidney Int Rep, 2024, 9(8): 2474-2483.
22
Yeggalam A, Liebich JA, Yu K, et al. Safety and efficacy of sodium-glucose co-transporter-2 inhibitors in patients with kidney transplantation and diabetes mellitus[J]. Diabetes Obes Metab, 2023, 25(6): 1777-1780.
23
Sánchez Fructuoso AI, Bedia Raba A, Banegas Deras E, et al. Sodium-glucose cotransporter-2 inhibitor therapy in kidney transplant patients with type 2 or post-transplant diabetes: an observational multicentre study[J]. Clin Kidney J, 2023, 16(6): 1022-1034.
24
Mahmoud T, Yagan J, Hasan A, et al. Sodium-glucose co-transporter 2 inhibitors & glucagon-like peptide-1 receptor agonists, efficacy & safety in diabetic kidney transplant recipients[J]. Clin Transplant, 2023, 37(12): e15144.
25
Demir ME, Özler TE, Merhametsiz Ö,et al. The results of SGLT-2 inhibitors use in kidney transplantation: 1-year experiences from two centers[J]. Int Urol Nephrol, 2023, 55(11): 2989-2999.
26
刘金瑞,张靖华,吴秋杰,等. 钠-葡萄糖协同转运蛋白2抑制剂达格列净对2型糖尿病肾病肾移植患者血糖及肾功能的影响[J]. 临床内科杂志,2022, 39(2): 97-100.
27
Miyazaki R, Miyagi K. Empagliflozin in kidney transplant recipients with chronic kidney disease G3a-4 and metabolic syndrome: five Japanese cases[J]. BMC Nephrol, 2022, 23(1): 168.
28
Lim JH, Kwon S, Jeon Y, et al. The efficacy and safety of SGLT2 inhibitor in diabetic kidney transplant recipients[J]. Transplantation, 2022, 106(9): e404- e412.
29
Lemke A, Brokmeier HM, Leung SB, et al. Sodium-glucose cotransporter 2 inhibitors for treatment of diabetes mellitus after kidney transplantation [J]. Clin Transplant, 2022, 36(8): e14718.
30
Song CC, Brown A, Winstead R, et al. Early initiation of sodium-glucose linked transporter inhibitors (SGLT-2i) and associated metabolic and electrolyte outcomes in diabetic kidney transplant recipients[J]. Endocrinol Diabetes Metab, 2021, 4(2): e00185.
31
Hisadome Y, Mei T, Noguchi H, et al. Safety and efficacy of sodium-glucose cotransporter 2 inhibitors in kidney transplant recipients with pretransplant type 2 diabetes mellitus: a retrospective, single-center, inverse probability of treatment weighting analysis of 85 transplant patients [J]. Transplant Direct, 2021, 7(11): e772.
32
AlKindi F, Al-Omary HL, Hussain Q, et al. Outcomes of SGLT2 inhibitors use in diabetic renal transplant patients[J]. Transplant Proc, 2020, 52(1): 175-178.
33
Shah M, Virani Z, Rajput P, et al. Efficacy and safety of canagliflozin in kidney transplant patients [J]. Indian J Nephrol, 2019, 29(4): 278-281.
34
Schwaiger E, Burghart L, Signorini L, et al. Empagliflozin in posttransplantation diabetes mellitus: a prospective, interventional pilot study on glucose metabolism, fluid volume, and patient safety[J]. Am J Transplant, 2019, 19(3): 907-919.
35
Mahling M, Schork A, Nadalin S, et al. Sodium-glucose cotransporter 2 (SGLT2) inhibition in kidney transplant recipients with diabetes mellitus [J]. Kidney Blood Press Res, 2019, 44(5): 984-992.
36
Halden TAS, Kvitne KE, Midtvedt K, et al. Efficacy and safety of empagliflozin in renal transplant recipients with posttransplant diabetes mellitus[J]. Diabetes Care, 2019, 42(6): 1067-1074.
37
Attallah N, Yassine L. Use of empagliflozin in recipients of kidney transplant: a report of 8 cases [J]. Transplant Proc, 2019, 51(10): 3275-3280.
38
Rajasekeran H, Kim SJ, Cardella CJ, et al. Use of canagliflozin in kidney transplant recipients for the treatment of type 2 diabetes: a case series [J]. Diabetes Care, 2017, 40(7): e75- e76.
39
Mahalwar G, Mathew RO, Rangaswami J. Sodium-glucose cotransporter 2 inhibitors and cardiorenal outcomes in kidney transplantation[J]. Curr Opin Nephrol Hypertens, 2024, 33(1): 53-60.
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