kidney transplant recipients, as they have the same and even more pronounced cardiovascular risk factors than the general population and in addition, we got better in improving graft and patients survival in the short term, but we lack the tools to improve long term patients and graft survival where so many patients die from cardiovascular disease with a functioning graft or lose their graft from chronic changes and chronic antibody-mediated rejection with difficult to control blood pressure and proteinuria For these reasons, we might need more powerful tools, like the SGLT2i bearing in mind the unique side effects that might be amplified in kidney transplant recipients receiving immunosuppression like urinary tract infection, and the dip in serum creatinine. Methods: We collected data retrospectively from transplant records of patients with type II diabetes mellitus (T2D) or post-transplant diabetes mellitus (PTDM) (n=79) who were receiving SGLT2i agents plus standard of care [SOC] management and compared them to (n=56) similar diabetic patients who were only on SOC management.Results: The two groups were comparable regarding age, sex, type of donor, type of diabetes (T2D or PTDM), post-transplant period, induction immunosuppression, and use of CNI. Though improvement of HbA1c was not significantly different between the two groups, patients on SGLT2i showed a better drop in HbA1c compared to the SOC group (0.7% versus 0.5% respectively). Reduction of BMI was equal between the two groups (-1.1%) and there was no significant difference in the number of blood pressure medications (average 2 drugs per patient). Kidney function was assessed by the eGFR using the CKD-EPI equation and by urine albumin/creatinine ratio (ACR). The eGFR was calculated at the start then at 1,3,6 and 12 months. In the SGLT2i group, eGFR showed a dip at 3 months (from 66 to 63.35 ml/min) then started to improve gradually toward the end of the year and maintained at a level close to baseline (65.44 ml/min). The SOC group showed a gradual drop in eGFR over the year from 65.76 to 63.19 ml/min. Urine ACR reduced in the SGLT2i group from 48.79 to 23.79 mg/mmol creatinine and increased from 42.84 to 63.16 mg/mmol creatinine in the SOC group. The incidences of graft rejection, urinary tract infection, genital infection, myocardial infarction, heart failure, or cerebrovascular stroke were not different between the groups. Conclusions: Use of SGLT2i in managing diabetic patients post kidney transplantation is safe and has better short-term outcomes on renal function with comparable safety compared to standard of care therapy.
and complement). Clinical features included need for dialysis, kidney sizes on ultrasound, oedema and blood pressure. History of tenofovir, rifampicin and co-trimoxazole use were documented, as well as dates of ART and TB treatment. Creatinine, eGFR and UPCR were collected up to 24 months. Mortality was recorded from electronic clinical records and HIV clinics. Results: Of the 538 biopsies reviewed, the majority were black African (87%), the median age was 36.8 years. Eighteen percent of patients were on ART in 2006 which peaked at 97% in 2016 and has subsequently declined to 70%. 7.8% of patients had hypertension, 3.7% diabetes and 17% were coinfected with Hepatitis B. There was a reduction in the proportion with HIVAN [80% of biopsies in 2005 declined to 20% however has been rising since 2017].The proportion of patients having an ICGNs was stable over the study period. The most common ICGN was membranoproliferative GN. There was a notable rise in tubulointerstitial disease [119 patients]; 64 had granulomatous intersitital nephritis [GIN], 20 had acute interstitial nephritis [AIN]. There has been a specific increase in the proportion of GIN from 2005 which peaked at 70% in the 2014 with a gradual decline to 25%. ART improved survival in all subgroups. Improvement in renal function was not association with ART in the ICGN group. The survival of patients with GIN was poor without ART. Conclusions: ART therapy has shifted the landscape of HIV-associated kidney disease however there is a disturbing increase in HIVAN over the last couple of years which may be attributed to nonadherence. Tuberculosis is also impacting significantly on renal disease in SA. The spectrum of kidney disease in HIV is clearly influenced by regional factors.
Conclusions: Among CKD-ND patients prescribed ONS, there were improvements in longitudinal trajectories of nutrition/inflammation parameters following the first ONS prescription. These results demonstrate effectiveness of the ONS program for CKD-ND patients. Future analyses comparing responses to ONS among different subgroups of patients with protein energy wasting/undernutrition will assist with determining which patients may have the greatest benefit from ONS intervention.
vs 13.4% p = 0.001), however the percentage of the population with TSH at a critical value $20 mlU/L was similar in both groups (2.4%).When comparing GFR according to TSH values, a significant difference was found in renal function in subjects with TSH $20 compared to the other groups (79.2AE31 vs 92.6AE30 ml/min p=#0.001). Furthermore, FT3 levels decreased directly in relation to the lower degree of renal function; 81% of subjects with GFR #15 ml/min have decreased FT3 values, 67% of them have normal TSH values; only 13% of the subjects with GFR $60 ml/min had a decrease in T3 values (p=#0.001). FT4 levels also decreased directly in relation to the lower degree of renal function (p=#0.001).Conclusions: CKD patients have a high incidence of thyroid abnormalities, low T3 syndrome is highly prevalent in subjects with GFR #15 ml/min, this is worrisome as low T3 has been associated with higher morbi-mortality in dialysis patients.
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