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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2024; 07(02): 066-076
DOI: 10.1055/s-0044-1782673
Review Article

Sodium-Glucose Cotransporter 2 Inhibitors' Mechanism of Action and Use in Kidney Transplantation Recipients: Extended Review and Update

Elmukhtar Habas
1   Department of Medicine, Hamad Medical Corporation, Doha, Qatar
,
Ala Habas
2   Department of Internal Medicine, Tripoli Central Hospital, Tripoli, Libya
,
Islam Elzouki
1   Department of Medicine, Hamad Medical Corporation, Doha, Qatar
,
Gamal Alfitori
1   Department of Medicine, Hamad Medical Corporation, Doha, Qatar
,
Elmehdi Arrayes
1   Department of Medicine, Hamad Medical Corporation, Doha, Qatar
,
Amnna Rayani
3   Department of Nephrology, Tripoli Children Hospital, Tripoli, Libya
,
Kalifa Farfar
1   Department of Medicine, Hamad Medical Corporation, Doha, Qatar
,
Eshrak Habas
4   Department of Medicine, Faculty of Medicine, University of Tripoli, Tripoli, Libya
,
Abdel-Naser Elzouki
5   Department of Medicine, Hamad Hamad Medical Corporation, College of Medicine, Qatar University, Doha, Qatar
› Author Affiliations Funding and Sponsorship None.
› Further Information
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Abstract

Five sodium-glucose cotransporters (SGLTs) protein family members are important for regulating blood glucose levels. The essential cotransporters for glucose reabsorption by proximal convoluted tubule are SGLT1 and 2. The newest recommendations advocate GLT2 inhibitors as first-line treatment for type 2 diabetes (T2D) with and without chronic kidney disease (CKD), improving CKD and cardiovascular outcomes.

SGLT2 inhibitors enhance kidney transplant patients' life quality, delay CKD progression, have renoprotective effects, and reduce cardiovascular disease in CKD patients, despite minimal published evidence on the usage of SGLT2 inhibitors in kidney transplantation recipients (KTxRs) with T2D or new-onset T2D. They preserve and improve renal function and cardiovascular outcomes in KTxRs. SGLT2 inhibitors' safety issues have prevented KTxRs from participating in major randomized studies, leaving doctors and patients unsure whether these extraordinary drugs outweigh the risks.

This extended review analyzes the established mechanisms through which SGLT2 inhibitors exert their positive effects, evaluate the potential advantages and drawbacks of these agents in KTx, and examine the current research findings on using SGLT2 inhibitors in KTxRs. Additionally, potential avenues for future research will be suggested. Different phrases were used to search for recent original and review articles published between January 2020 and November 2023 in PubMed, Google Scholar, Scopus, EMBASE, and Google to achieve the review objectives.

Keywords

kidney transplantation - SGLT2 physiology - glucose kidney reabsorption - SGLT2 inhibitor - SGLT2i in kidney transplantation

Authors' Contributions

All the named authors contributed to the conception, data collection, critical review of the literature, and manuscript drafting and finalization. They all reviewed the final version of the manuscript before its submission and they all accept collective responsibility for its contents.


Compliance with Ethical Principles

No prior ethical approval is required for review article type of study.




Publication History

Article published online:
23 April 2024

© 2024. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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