Bartoli Giulia, Dello Strologo Andrea, Arena Maria, Ceravolo Maria Josè, Mitterhofer Anna Paola, Pesce Francesco, Grandaliano Giuseppe
Nephrology and Dialysis Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy.
Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Int J Mol Sci. 2025 Jun 20;26(13):5952. doi: 10.3390/ijms26135952.
Diabetes mellitus (DM) is frequent in kidney transplant recipients (KTRs), reducing graft and patient survival. In recent years, hypoglycemic agents have been approved for chronic kidney disease (CKD) patients, such as sodium glucose co-transporter type 2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP1RAs), and nonsteroidal mineralocorticoid receptor antagonists (ns-MRAs), such as finerenone. Several studies demonstrated the ability of these drugs to reduce cardiovascular (CV) events and kidney disease progression in diabetic CKD patients. In this review, we will describe their use in KTRs with type 2 DM or post-transplant diabetes mellitus (PTDM), focusing on the potential positive effects. In particular, we will report literature data from observational studies, meta-analyses, and clinical trials. Based on their mechanism of actions, these drugs may balance the negative effects of immunosuppressive therapy on metabolic balance, reducing the risk of PTDM and CV events, that remain the first cause of death in KTRs. Generally, SGLT2is and GLP1RAs appear to be safe and efficacious in KTRs, and no interaction with immunosuppressive drugs or an increased risk of rejection has been reported. Regarding finerenone, no literature data are available and only one clinical trial is ongoing. In conclusion, although the 2022 KDIGO guidelines recommend caution in KTRs, the last meeting in Vienna on PTDM encourages their use in this population.
糖尿病（DM）在肾移植受者（KTRs）中很常见，会降低移植物和患者的生存率。近年来，降糖药物已被批准用于慢性肾脏病（CKD）患者，如钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is）、胰高血糖素样肽-1受体激动剂（GLP1RAs）以及非甾体类盐皮质激素受体拮抗剂（ns-MRAs），如非奈利酮。多项研究表明，这些药物能够降低糖尿病CKD患者发生心血管（CV）事件和肾病进展的风险。在本综述中，我们将描述它们在2型糖尿病或移植后糖尿病（PTDM）的KTRs中的应用，重点关注潜在的积极作用。特别是，我们将报告观察性研究、荟萃分析和临床试验的文献数据。基于它们的作用机制，这些药物可能会平衡免疫抑制治疗对代谢平衡的负面影响，降低PTDM和CV事件的风险，而CV事件仍是KTRs的首要死因。一般来说，SGLT2is和GLP1RAs在KTRs中似乎是安全有效的，且未报告与免疫抑制药物有相互作用或排斥风险增加。关于非奈利酮，尚无文献数据，仅有一项临床试验正在进行。总之，尽管2022年KDIGO指南建议对KTRs谨慎用药，但最近在维也纳召开的关于PTDM的会议鼓励在这一人群中使用这些药物。
