Role of Sodium-Glucose Cotransporter 2 inhibitors for management of diabetes mellitus in renal transplant recipients; and management strategies for post-transplant hypertension.

Background Diabetes mellitus and hypertension are the leading causes of cardiovascular disease in renal transplant recipients. This review looks at the potential role of sodium-glucose co-transporter 2 inhibitors (SGLT2is) and reviews the management strategies for hypertension in this population. Summary Large-scale clinical trials are needed to study the potential cardiorenal benefits and risks of complications in renal transplant recipients. Future clinical trials are also needed to define optimal blood pressure treatment goals and therapies and how they influence graft and patient survival. Key Messages Multiple recent prospective randomized clinical trials have shown the benefits of using SGLT2is to improve cardiorenal outcomes in patients with chronic kidney disease with or without diabetes mellitus. Renal transplant recipients were not included in these trials due to concerns about genitourinary complications. Hence the role of these agents in this population is unclear. A number of small studies have highlighted the safety of using these agents in renal transplant recipients. Post-transplant hypertension is a complex problem requiring individualized management. Recent guidelines recommend using a calcium channel blocker or angiotensin receptor blocker as the first-line anti-hypertensive agents in adult renal transplant recipients.