Efficacy and Mechanisms of Dapagliflozin in Promoting Kidney Function and Cardiovascular Health in Kidney Transplant Recipients

Inclusion Criteria: * Age 18-80 years * Kidney transplant received 1 year prior to randomization * estimated glomerular filtration rate 30-90 ml/min/1.73m2 * Urine albumin to creatinine ratio (ACR) 30-5000 mg/g * Pre-existing type 2 diabetes or post-transplant diabetes mellitus * Blood pressure \<130/80 mm Hg prior to randomization * Able to provide informed consent * Stable immunosuppression for at least 3 months prior to baseline consisting of tacrolimus, mycophenolate mofetil/mycophenolic acid and prednisone * Stable anti-hypertensive regimen for at least 1month prior to baseline * Stable diabetes management for at least 3 months prior to baseline * Stable angiotensin converting enzyme inhibitor/angiotensin receptor blocker use for at least 3 months prior to baseline (if applicable) * Glucagon-like peptide-1 receptor agonist (GLP-1RA) for at least 3 months prior to baseline (if applicable) Exclusion Criteria: * Type 1 diabetes * Anticipated life expectancy \<1 year * Uncontrolled hypertension * Hemoglobin A1c \>9% * Body mass index \>40 kg/m2 * New York Heart Association Class 3 or 4 heart failure symptoms, an EF ≤30%, or hospitalization for heart failure in the past 3 months * Pregnancy, plans to become pregnant, or breastfeeding * Current use of sodium glucose cotransporter-2 (SGLT2) inhibitors * Current urinary or urogenital infection * Use of anticoagulants (contraindication to kidney biopsy) * Magnetic resonance imaging (MRI) contraindications * History of lower-limb amputation irrespective of etiology * Known hypersensitivity to dapagliflozin