Hyperuricemia management in chronic kidney disease is a challenging task. We encounter this dilemma on regular basis. Kidney disease patients have wide range (CKD population, Hemodialysis & peritoneal dialysis cohort and renal transplant patients).In clinical practice wide range of opinions exists. This dubious area intrigued us to look into it. Looking into available published data majority of studies are observational and few are randomized control trials. All studies favor that high uric acid level has accelerated effect on CKD progression. Controversy is on its management, whether by treating it we are able to slow down CKD progression or not. Data supports that CKD progression is not slowed down but needs more studies to give conclusive answer. In dialysis and renal transplant patients studies showed inverse relationship of high uric levels with all-cause mortality. However, in peritoneal dialysis data suggests linear relationship of hyperuricemia with mortality.A pro as well as anti-oxidant effect of uric acid has been discussed in literature. Variable cut off for hyperuricemia has been used but more census is on 7 mg/dl. Symptomatic gout defi nitely needs uric acid lowering therapy but in asymptomatic hyperuricemia no conclusion so far. There is paucity of data in maintenance dialysis and renal transplant patients.
Diabetes Mellitus (DM) is a potent risk factor for post-transplant cardiovascular complications and infections. Management of diabetes and its complications in renal transplant recipients is a challenging task. This is a frequently encountered predicament in transplant setups. An erratic glycemic control during dialysis is a predictor of poor graft and patient outcomes after kidney transplantation. Literature review reveals majority studies explaining post-transplant diabetes and its role in graft and patient survival. However, a wide range of opinion exists about the impact of pre-transplant DM on transplant outcomes. Measurement of HbA1c levels is a significant tool for assessment of glycemic control. A target HbA1c level of <7% is recommended for diabetic patients irrespective of presence or absence of Chronic Kidney Disease (CKD). However, diabetic patients with CKD are at risk of hypoglycemia owing to decreased insulin metabolism so it is safe to keep HbA1c levels between 7-8% in this population. Immunosuppressive medications have a strong contributory role in deterioration of glycemic control. So, it is imperative to achieve strict pre-transplant diabetes control in order to avoid post-transplant complications. Post-transplant diabetes mellitus (PTDM) has been a subject of a large number of trials and is not only considered a serious metabolic complication but also a predisposing factor of diabetic nephropathy in transplanted kidney.
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