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

doi:10.3877/cma.j.issn.1674-3903.2026.04.015

Abstract

Abstract:

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.

Key words: Kidney transplantation, Post-transplant diabetes mellitus, Sodium-glucose co-transporter 2 inhibitors

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]. Chinese Journal of Transplantation(Electronic Edition), 2026, 20(04): 306-312.

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References 39

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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

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

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