Background: Diabetes is the leading cause of end-stage renal disease (ESRD) worldwide. Also, diabetes is prevalent in kidney transplant recipients for nondiabetic reasons. Methodology: We used a mixed method methodology, including a case report, surveys of physicians’ opinions, and a review of the literature. Results: (A) A 58-year-old retired police officer was seen at the diabetes clinic in October 2015. His care was transferred from another physician who had relocated elsewhere. The patient’s medical history included type 2 diabetes for over 25 years, hyperlipidemia, hypertension, diabetic neuropathy, diabetic nephropathy, and diabetic retinopathy in addition to vitamin D deficiency and morbid obesity. He had received a renal transplant from a nonrelated live donor 7 years previously. His medications included sitagliptin 50 mg/day, gliclazide (modified release) 60–90 mg/day, metformin (extended release) 750 mg twice daily, and dapagliflozin 10 mg/day. We focus on the off-license use of dapagliflozin in a patient with a history of ESRD and renal transplantation. The lack of published experience with sodium-glucose cotransporter 2 (SGLT2) inhibitors in renal transplant recipients was discussed with him. “But I came to no harm,” was his reply. His records on renal function, hydration status, and glycemic control all seemed unaffected over the previous 2.5 years. He remains well till the time of this report. Serum electrolytes, creatinine, plasma albumin, hemoglobin, packed cell volume, and estimated glomerular filtration rate (eGFR) were not adversely affected. Glycated hemoglobin and fasting blood glucose were stable. Urine was consistently negative for ketones but loaded with glycosuria. It was agreed to continue with the same medication, observe the patient carefully, and seek for opinions of other physicians. (B) An online survey was conducted; the responses revealed that many physicians would use SGLT2 inhibitors in renal transplant recipients provided the renal function was satisfactory with an eGFR > 60. We have learned of an ongoing trial on SGLT2 inhibitors in renal transplant recipients. (C) A case series of 10 patients treated with canagliflozin showed reassuring findings. Conclusions: Despite the lack of formal trial evidence, the index case suggested the safe use of SGLT2 inhibitors by renal transplant recipients for a remarkably extended period of 2.5 years. Physicians seem willing to use SGLT2 inhibitors in this group of patients provided renal function is satisfactory.

中文翻译：

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SGLT2 抑制剂在糖尿病肾移植受者中的使用：混合方法探索性练习

背景：糖尿病是全球终末期肾病（ESRD）的主要原因。此外，由于非糖尿病原因，糖尿病在肾移植受者中很普遍。方法：我们使用了混合方法方法，包括病例报告、医生意见调查和文献回顾。结果： (A) 2015 年 10 月，一名 58 岁的退休警官在糖尿病诊所就诊。他的护理从另一位搬到别处的医生那里转移。患者的病史包括 2 型糖尿病超过 25 年、高脂血症、高血压、糖尿病神经病变、糖尿病肾病和糖尿病视网膜病变，此外还有维生素 D 缺乏和病态肥胖。7 年前，他接受了来自非血缘活体捐献者的肾移植。他的药物包括西格列汀 50 毫克/天，格列齐特（缓释）60-90 毫克/天，二甲双胍（缓释）750 毫克，每天两次，达格列净 10 毫克/天。我们专注于在有 ESRD 和肾移植史的患者中未经许可使用达格列净。与他讨论了在肾移植受者中缺乏钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂的已发表经验。“但我没有受到伤害，”是他的回答。在过去的 2.5 年里，他的肾功能、水合状态和血糖控制记录似乎都没有受到影响。直到本报告发布时，他都保持良好状态。血清电解质、肌酐、血浆白蛋白、血红蛋白、细胞堆积体积和估计的肾小球滤过率 (eGFR) 没有受到不利影响。糖化血红蛋白和空腹血糖稳定。尿液中酮体始终呈阴性，但含有糖尿。同意继续使用相同的药物，仔细观察患者，并征求其他医生的意见。(B) 进行了在线调查；答复表明，许多医生会在肾移植受者中使用 SGLT2 抑制剂，前提是肾功能令人满意且 eGFR > 60。我们了解到正在进行的肾移植受者中 SGLT2 抑制剂试验。(C) 用卡格列净治疗的 10 名患者的病例系列显示令人欣慰的发现。结论：尽管缺乏正式的试验证据，指示病例表明肾移植受者可以安全使用 SGLT2 抑制剂达 2.5 年的显着延长。