Increase in serum magnesium and metabolic effects of SGLT2 inhibitor treatment in kidney transplant patients

Hypomagnesemia is a common and clinically relevant complication in kidney transplant recipients, associated with an increased risk of graft dysfunction, metabolic disturbances, and cardiovascular events. Sodium-glucose cotransporter type 2 inhibitors (SGLT2i), drugs widely used in type 2 diabetes mellitus and chronic kidney disease, may provide additional benefits in this context by improving magnesium levels. In this retrospective study, 94 kidney transplant patients treated with SGLT2i were analyzed, evaluating biochemical and metabolic parameters before and after treatment initiation. A significant increase in serum magnesium concentrations was observed, from 1.70 ± 0.27 mg/dL to 1.81 ± 0.25 mg/dL (p < 0.001), accompanied by improved glycemic control and metabolic profile, with reductions in blood glucose, glycated hemoglobin, uric acid, ferritin, and body weight. Serum phosphorus showed a slight increase (p = 0.008) and bicarbonate a mild decrease (p = 0.049), without clinical impact or deterioration in estimated glomerular filtration rate. These findings are consistent with recent evidence highlighting the beneficial effect of SGLT2 inhibitors on serum magnesium and their safety in kidney transplantation. Overall, the results support the hypothesis that SGLT2 inhibitors represent a promising therapeutic option for kidney transplant recipients with hypomagnesemia, combining metabolic, renal, and cardiovascular protection.