Association of British Clinical Diabetologists and Renal Association guidelines on the detection and management of diabetes post solid organ transplantation

Chowdhury, Tahseen A; Wahba, Mona; Mallik, Ritwika; Peracha, Javeria; Patel, Dipesh; De, Parijat; Fogarty, Damian; Frankel, Andrew; Karalliedde, Janaka; Mark, Patrick B.; Montero, Rosa; Pokrajac, Ana; Zac‐Varghese, Sagen; Bain, Stephen C.; Dasgupta, Indranil; Banerjee, Debasish; Winocour, Peter; Sharif, Adnan

doi:10.1111/dme.14523

Cited by 29 publications

(35 citation statements)

References 53 publications

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“…While patient survival in the prior era (2000–2011) was comparable among SCD recipients and diabetic recipients [ 13 ], our study shows better patient survival among diabetic recipients compared with SCD recipients. Given that there is no difference between patient survival among SCD in years 2010–2019 when compared to years 2000–2009, this finding likely reflects a significant improvement in diabetes care post kidney transplantation for the past decade [ 40 , 41 , 42 ]. Kidney transplant recipients with SCD still have complications of SCD post-transplant [ 20 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

Leeaphorn

Vaitla

Hansrivijit

et al. 2021

JCM

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Background: Lower patient survival has been observed in sickle cell disease (SCD) patients who go on to receive a kidney transplant. This study aimed to assess the post-transplant outcomes of SCD kidney transplant recipients in the contemporary era. Methods: We used the OPTN/UNOS database to identify first-time kidney transplant recipients from 2010 through 2019. We compared patient and allograft survival between recipients with SCD (n = 105) vs. all other diagnoses (non-SCD, n = 146,325) as the reported cause of end-stage kidney disease. We examined whether post-transplant outcomes improved among SCD in the recent era (2010–2019), compared to the early era (2000–2009). Results: After adjusting for differences in baseline characteristics, SCD was significantly associated with lower patient survival (HR 2.87; 95% CI 1.75–4.68) and death-censored graft survival (HR 1.98; 95% CI 1.30–3.01), compared to non-SCD recipients. The lower patient survival and death-censored graft survival in SCD recipients were consistently observed in comparison to outcomes of recipients with diabetes, glomerular disease, and hypertension as the cause of end-stage kidney disease. There was no significant difference in death censored graft survival (HR 0.99; 95% CI 0.51–1.73, p = 0.98) and patient survival (HR 0.93; 95% CI 0.50–1.74, p = 0.82) of SCD recipients in the recent versus early era. Conclusions: Patient and allograft survival in SCD kidney recipients were worse than recipients with other diagnoses. Overall SCD patient and allograft outcomes in the recent era did not improve from the early era. The findings of our study should not discourage kidney transplantation for ESKD patients with SCD due to a known survival benefit of transplantation compared with remaining on dialysis. Urgent future studies are needed to identify strategies to improve patient and allograft survival in SCD kidney recipients. In addition, it may be reasonable to assign risk adjustment for SCD patients.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

Leeaphorn

Vaitla

Hansrivijit

et al. 2021

JCM

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“…Patients with afternoon hyperglycaemia should undergo OGTT when clinically stable. 71 The reason for afternoon testing is that hyperglycaemic peaks tend to occur in the afternoon. 72 …”

Section: Post-transplantation Diabetes Mellitusmentioning

confidence: 99%

“…As there is no high-level evidence to support the use of stringent glycaemic targets in patients post-transplantation, the ABCD-RA advises the same targets as for type 2 diabetes 71 ( Table 1 ). The National Institute for Health and Care Excellence (NICE) suggests individualising the glycaemic target to the patient.…”

Section: Post-transplantation Diabetes Mellitusmentioning

confidence: 99%

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Diabetes mellitus in dialysis and renal transplantation

Ben-David

Hull

Banerjee

2021

Therapeutic Advances in Endocrinology

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Diabetes mellitus is the commonest cause of end-stage kidney failure worldwide and is a proven and significant risk factor for the development of cardiovascular disease. Renal impairment has a significant impact on the physiology of glucose homeostasis as it reduces tissue sensitivity to insulin and reduces insulin clearance. Renal replacement therapy itself affects glucose control: peritoneal dialysis may induce hyperglycaemia due to glucose-rich dialysate and haemodialysis often causes hypoglycaemia due to the relatively low concentration of glucose in the dialysate. Autonomic neuropathy which is common in chronic kidney disease (CKD) and diabetes increases the risk for asymptomatic hypoglycaemia. Pharmacological options for improving glycaemic control are limited due to alterations to drug metabolism. Impaired glucose tolerance and diabetes are also common in the post-kidney-transplant setting and increase the risk of graft failure and mortality. This review seeks to summarise the literature and tackle the intricacies of glycaemic management in patients with CKD who are either on maintenance haemodialysis or have received a kidney transplant. It outlines changes to glycaemic targets, monitoring of glycaemic control, the use of oral hypoglycaemic agents, the management of severe hyperglycaemia in dialysis and kidney transplantation patients.

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“…19 Guidance on the diagnosis, management and prevention of PTDM have been developed by the ABCD and RA. 20…”

Section: Post-transplant Diabetes Mellitusmentioning

confidence: 99%

Diabetes and the kidney

Chowdhury

Ali

2021

Clinical Medicine

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Diabetes is the most common cause of end-stage kidney disease. Randomised controlled trials have shown a significant benefit of sodium-glucose transporter-2 inhibitors in patients with diabetic kidney disease (DKD), and guidelines now suggest these drugs should be considered in all patients with DKD irrespective of glucose control. Glucagon-like peptide-1 receptor agonists have shown some benefit in reducing progression of albuminuria in DKD and should also be considered early in the therapeutic pathway. Management of diabetes in patients on renal replacement therapy (dialysis or transplantation) is uniquely challenging. This article outlines guidance on management of glucose in these vulnerable groups of patients. Management of DKDManagement of DKD involves tight control of blood pressure (<130/80 mmHg) using angiotensin converting enzyme inhibitors ABSTRACT Key pointsDiabetic kidney disease is an important cause of end-stage renal disease, and early detection and management may prevent or delay development of renal failure.

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Association of British Clinical Diabetologists and Renal Association guidelines on the detection and management of diabetes post solid organ transplantation

Cited by 29 publications

References 53 publications

Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

Diabetes mellitus in dialysis and renal transplantation

Diabetes and the kidney

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