# GLP-1-remmers, SGLT2-remmers en MRAs kunnen veilig worden gecombineerd met immuunsuppressie bij niertransplantatie

*geplaatst 2026-11-14 · Hartfalen · Current opinion in nephrology and hypertension · doi 10.1097/MNH.0000000000001237 · https://hartvaat.nl/2026/11/06/glp-1-remmers-sglt2-remmers-en-mras-kunnen-veilig-worden-gecombineerd-met-immuun/*

Deze review presenteert een praktisch raamwerk voor het toevoegen van GLP-1-remmers, SGLT2-remmers en MRAs aan de immuunsuppressie bij niertransplantatiepatiënten. Hoewel overlevingsdata ontbreken, wijzen beschikbare studies op verbeterde glycemieregeling, bloeddruk, eiwituitscheiding en cardiorenale risicofactoren zonder dat de immuunsuppressie standaard aangepast hoeft te worden. Voor de praktijk betekent dit dat deze middelen individueel en sequentieel kunnen worden ingezet, mits er nauwlettend wordt gemonitord op interacties, nierfunctie, elektrolyten en CNI-trougniveaus.

## English: A practical framework for using GLP-1 RAs, SGLT2i, and MRAs with contemporary immunosuppression in kidney transplant recipients.

This review outlines a practical framework for integrating GLP-1 receptor agonists, SGLT2 inhibitors, and mineralocorticoid receptor antagonists into maintenance immunosuppression for kidney transplant recipients. While long-term graft and patient survival benefits remain unproven, existing data indicate improvements in glycaemic control, blood pressure, proteinuria, and cardiorenal risk without routinely requiring immunosuppression dose adjustments. Clinicians should introduce these agents sequentially and monitor closely for drug interactions, volume status, renal function, and calcineurin inhibitor trough levels to ensure safety.

## Abstract (original, from the publication)

PURPOSE OF REVIEW: Calcineurin inhibitors (CNIs) remain central to kidney-transplant (KTX) immunosuppression (IS) but contribute to nephrotoxicity and cardiometabolic (CM) complications which negatively affect patient and graft survival. This review presents a practical framework for adding glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and mineralocorticoid receptor antagonists (MRAs) to established IS regimens. These agents complement individualized optimization of IS, including CNI-sparing strategies when indicated. RECENT FINDINGS: Evidence in KTX recipients remains limited, but available studies suggest that these agents may improve glycemic control, weight, blood pressure, proteinuria, and cardiorenal risk without routinely requiring changes to IS choice or dose. Whether these changes improve patient and graft survival remains unproven. GLP-1 RA related gastrointestinal effects may alter oral IS absorption, warranting continued CNI trough monitoring, particularly when significant gastrointestinal symptoms occur after initiation or dose escalation. SGLT2i require assessment of volume status, renal-function, and infection risk. MRAs may compound CNIs associated hyperkalemia and early eGFR decline, requiring close potassium and renal-function monitoring. SUMMARY: These therapies may extend cardiorenal benefits observed in nontransplant chronic kidney disease to selected KTX recipients. Their use should be individualized, introduced sequentially, and supported by monitoring of graft function, electrolytes, volume status, blood pressure, and IS exposure. Temporary withholding should follow drug-specific perioperative and sick-day guidance, particularly for SGLT2i.

Auteurs: Basset El Essawy, Faatimah Maryam Muzammil, Ibrahem El Essawy

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Bron: Current opinion in nephrology and hypertension, https://doi.org/10.1097/MNH.0000000000001237. Bijgewerkt 2026-11-07T02:32:24Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.