Introduction: Diabetes is the most common cause of chronic kidney disease (CKD) globally. The renal and cardio-vascular benefits of the new anti-diabetic agents are not assessed comprehensively. 
Aim of the study: We aimed to evaluate the short term renal and cardio-protective effects of Sodium-Glucose Cotransporter-2 Inhibition (SGLT2i) Vs. Dipeptidyl peptidase-4 Inhibition (DPP4i) among diabetic kidney transplant recipients.
Patients and methods: In this observational trial, 222 diabetic kidney transplants recipients (NODAT or type 2 diabetes) were enrolled and were categorized into two groups. Group 1 (n=99) received SGLT2i while group 2(n=123) received DPP4i as an add on antidiabetic medications. All patients in the two groups were followed up for 12 months.
Results: Most patients in the two groups (1&2) were men (59.6 vs. 61.7%, p=0.73) in their middle age (58.5±11.9 vs. 54.4±12.9, p=0.016) years respectively. The two groups were matched regarding their demographics especially the type of donor, type of immunosuppression (induction or maintenance), number of cardiovascular events before enrollment in the study and the number of patients who were maintained on ACEi or ARB(p>0.05).
The minority of patients were smokers (12.9 vs.8.7%), and chronic glomerulonephritis was the original disease in 36.4 vs. 35.4% in the two groups, respectively. Most of the enrolled patients (72.8 vs. 78.6%) underwent hemodialysis pre-transplant. During follow up period, patients in both groups were comparable regarding mean blood pressure, body weight, HbA1C, 24-hour urine protein, and graft function (represented by the mean serum creatinine) at different time intervals and compared to base line values(p>0.05). However, the mean HbA1C was significantly higher in group 1 during the whole follow up period of the study (p<0.05) but it did not drop significantly compared to baseline values (p>0.05). We did not report any macroangiopathic events (cerebral stroke, acute myocardial infection, or peripheral arterial disease) in the two groups during the study.
Conclusion: Both GLT2i and DPP-4 I are comparable regarding renal and cardio-vascular protection among diabetic kidney transplant recipients.