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Recent advances in new-onset diabetes mellitus after kidney transplantation
A common challenge in managing kidney transplant recipients (KTR) is post-transplant diabetes mellitus (PTDM) or diabetes mellitus (DM) newly diagnosed after transplantation, in addition to known pre-existing DM. PTDM is an important risk factor for post-transplant cardiovascular (CV) disease, which...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107982/ https://www.ncbi.nlm.nih.gov/pubmed/33995843 http://dx.doi.org/10.4239/wjd.v12.i5.541 |
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author | Montada-Atin, Tess Prasad, G V Ramesh |
author_facet | Montada-Atin, Tess Prasad, G V Ramesh |
author_sort | Montada-Atin, Tess |
collection | PubMed |
description | A common challenge in managing kidney transplant recipients (KTR) is post-transplant diabetes mellitus (PTDM) or diabetes mellitus (DM) newly diagnosed after transplantation, in addition to known pre-existing DM. PTDM is an important risk factor for post-transplant cardiovascular (CV) disease, which adversely affects patient survival and quality of life. CV disease in KTR may manifest as ischemic heart disease, heart failure, and/or left ventricular hypertrophy. Available therapies for PTDM include most agents currently used to treat type 2 diabetes. More recently, the use of sodium glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and dipeptidyl peptidase 4 inhibitors (DPP4i) has cautiously extended to KTR with PTDM, even though KTR are typically excluded from large general population clinical trials. Initial evidence from observational studies seems to indicate that SGLT2i, GLP-1 RA, and DPP4i may be safe and effective for glycemic control in KTR, but their benefit in reducing CV events in this otherwise high-risk population remains unproven. These newer drugs must still be used with care due to the increased propensity of KTR for intravascular volume depletion and acute kidney injury due to diarrhea and their single-kidney status, pre-existing burden of peripheral vascular disease, urinary tract infections due to immunosuppression and a surgically altered urinary tract, erythrocytosis from calcineurin inhibitors, and reduced kidney function from acute or chronic rejection. |
format | Online Article Text |
id | pubmed-8107982 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-81079822021-05-15 Recent advances in new-onset diabetes mellitus after kidney transplantation Montada-Atin, Tess Prasad, G V Ramesh World J Diabetes Review A common challenge in managing kidney transplant recipients (KTR) is post-transplant diabetes mellitus (PTDM) or diabetes mellitus (DM) newly diagnosed after transplantation, in addition to known pre-existing DM. PTDM is an important risk factor for post-transplant cardiovascular (CV) disease, which adversely affects patient survival and quality of life. CV disease in KTR may manifest as ischemic heart disease, heart failure, and/or left ventricular hypertrophy. Available therapies for PTDM include most agents currently used to treat type 2 diabetes. More recently, the use of sodium glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and dipeptidyl peptidase 4 inhibitors (DPP4i) has cautiously extended to KTR with PTDM, even though KTR are typically excluded from large general population clinical trials. Initial evidence from observational studies seems to indicate that SGLT2i, GLP-1 RA, and DPP4i may be safe and effective for glycemic control in KTR, but their benefit in reducing CV events in this otherwise high-risk population remains unproven. These newer drugs must still be used with care due to the increased propensity of KTR for intravascular volume depletion and acute kidney injury due to diarrhea and their single-kidney status, pre-existing burden of peripheral vascular disease, urinary tract infections due to immunosuppression and a surgically altered urinary tract, erythrocytosis from calcineurin inhibitors, and reduced kidney function from acute or chronic rejection. Baishideng Publishing Group Inc 2021-05-15 2021-05-15 /pmc/articles/PMC8107982/ /pubmed/33995843 http://dx.doi.org/10.4239/wjd.v12.i5.541 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/ |
spellingShingle | Review Montada-Atin, Tess Prasad, G V Ramesh Recent advances in new-onset diabetes mellitus after kidney transplantation |
title | Recent advances in new-onset diabetes mellitus after kidney transplantation |
title_full | Recent advances in new-onset diabetes mellitus after kidney transplantation |
title_fullStr | Recent advances in new-onset diabetes mellitus after kidney transplantation |
title_full_unstemmed | Recent advances in new-onset diabetes mellitus after kidney transplantation |
title_short | Recent advances in new-onset diabetes mellitus after kidney transplantation |
title_sort | recent advances in new-onset diabetes mellitus after kidney transplantation |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107982/ https://www.ncbi.nlm.nih.gov/pubmed/33995843 http://dx.doi.org/10.4239/wjd.v12.i5.541 |
work_keys_str_mv | AT montadaatintess recentadvancesinnewonsetdiabetesmellitusafterkidneytransplantation AT prasadgvramesh recentadvancesinnewonsetdiabetesmellitusafterkidneytransplantation |