Recent advances in new-onset diabetes mellitus after kidney transplantation

Montada-Atin, Tess; Prasad, G. V. Ramesh

doi:10.4239/wjd.v12.i5.541

Cited by 9 publications

(9 citation statements)

References 99 publications

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“…A inclusão de pacientes variou; a TFG variou de 75 a 80 mL/min/1,73 m², limitando os dados sobre os efeitos da CKD avançada (TFG < 30 mL/min/1,73 m²). [18][19][20][21][22] A maioria dos participantes dos CVOTs de GLP1RA apresentava normoalbuminúria na linha de base, com cerca de 15% apresentando proteinúria (UACR > 300 mg/dL). A doença renal basal limitada impediu a avaliação dos efeitos do tratamento sobre os resultados renais dentro da duração do estudo.…”

Section: Discussionunclassified

“…A adesão variou de 76% (EXSCEL) a 86,5% (SUSTAIN 6). [18][19][20][21][22] No estudo LEADER, a liraglutide apresentou maior redução de MACE entre os pacientes com TGF < 60 mL/min. Além disso, a liraglutida reduziu efetivamente a incidência de DRC de início recente e desacelerou sua progressão, na maioria atribuída ao tratamento da macro Albuminuria persistente.…”

Section: Discussionunclassified

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Agonistas do Receptor de Peptídeo Semelhante ao Glucagon-1 em Transplantados Renais - Estudo Retrospectivo de um Centro Hospitalar

Freitas,

Silvano,

Ribeiro

et al. 2024

BJT

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Objetivos: A incidência de diabetes pós-transplante e o aumento do risco cardiovascular entre os receptores de transplante estão em ascensão. Os agonistas do receptor de peptídeo semelhante ao glucagon têm o potencial de mitigar os efeitos dos medicamentos imunossupressores, abordando tanto a hiperglicemia quanto o aumento de peso, o que os torna atrativos para uso nesta população, dadas as suas vantagens cardiovasculares e renoprotetoras. No entanto, a evidência atual é insuficiente sobre a sua eficácia em receptores de transplante renal diabéticos (RTRD). Métodos: O objetivo deste estudo retrospectivo foi avaliar a eficácia e segurança dos agonistas do peptídeo semelhante ao glucagon-1 em RTRD. O foco principal foi avaliar o seu impacto em vários parâmetros, tais como níveis de hemoglobina A1c, índice de massa corporal (IMC), perfil lipídico, níveis de hemoglobina, função do enxerto renal (taxa de filtração glomerular estimada [TFGe]) e relação proteína-creatinina urinária. Resultados: Durante um período de observação mediano de 18 meses, esta investigação incluiu 64 pacientes transplantados renais. A TFGe mediana no início foi de 61,9 mL/min/1,73 m2 e permaneceu estável durante o acompanhamento. A mediana da HbA1c diminuiu de 7,5 para 7% (IC95%; p < 0,002). Também foi observada uma melhoria significativa no IMC e no perfil lipídico. Não foram observadas mudanças significativas nos níveis medianos de creatinina e relação proteína:creatinina urinária. Nenhum efeito colateral justificou a descontinuação do medicamento. Conclusão: Este estudo mostra que o uso de agonistas do peptídeo semelhante ao glucagon é viável e bem tolerado em RTRD, sem efeitos colaterais significativos observados. Estudos subsequentes são necessários para explorar se esta terapêutica pode melhorar efetivamente a sobrevida do aloenxerto nesses pacientes.

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Section: Discussionunclassified

Agonistas do Receptor de Peptídeo Semelhante ao Glucagon-1 em Transplantados Renais - Estudo Retrospectivo de um Centro Hospitalar

Freitas,

Silvano,

Ribeiro

et al. 2024

BJT

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“…Of note, injectable GLP1 receptor agonists have substantial gastrointestinal adverse effects, which make them less well tolerated compared with DPP4is 154 . GLP1 receptor agonists should be used cautiously in patients with glucocorticoid-induced hyperglycaemia after renal transplantation owing to the potential for acute renal injury that is secondary to plasma volume contraction 164 .…”

Section: Current Treatment Optionsmentioning

confidence: 99%

Fresh insights into glucocorticoid-induced diabetes mellitus and new therapeutic directions

Cummins

2022

Nat Rev Endocrinol

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Glucocorticoid hormones were discovered to have use as potent anti-inflammatory and immunosuppressive therapeutics in the 1940s and their continued use and development have successfully revolutionized the management of acute and chronic inflammatory diseases. However, long-term use of glucocorticoids is severely hampered by undesirable metabolic complications, including the development of type 2 diabetes mellitus. These effects occur due to glucocorticoid receptor activation within multiple tissues, which results in inter-organ crosstalk that increases hepatic glucose production and inhibits peripheral glucose uptake. Despite the high prevalence of glucocorticoid-induced hyperglycaemia associated with their routine clinical use, treatment protocols for optimal management of the metabolic adverse effects are lacking or underutilized. The type, dose and potency of the glucocorticoid administered dictates the choice of hypoglycaemic intervention (non-insulin or insulin therapy) that should be provided to patients. The longstanding quest to identify dissociated glucocorticoid receptor agonists to separate the hyperglycaemic complications of glucocorticoids from their therapeutically beneficial anti-inflammatory effects is ongoing, with selective glucocorticoid receptor modulators in clinical testing. Promising areas of preclinical research include new mechanisms to disrupt glucocorticoid signalling in a tissue-selective manner and the identification of novel targets that can selectively dissociate the effects of glucocorticoids. These research arms share the ultimate goal of achieving the anti-inflammatory actions of glucocorticoids without the metabolic consequences.

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“…A pretransplant history of diabetes mellitus is an independent predictor of cerebrovascular accidents posttransplant [57,72]. Posttransplant diabetes development is associated with transplant-specific risk factors such as the use of diabetogenic immunosuppressive medications, posttransplant weight gain [73 ▪ ], older recipient age, deceased donor graft, and adult polycystic kidney disease [74 ▪ ]. After kidney transplant, one-third of nondiabetic kidney transplant recipients develop persistently impaired glucose metabolism by 6 months [75].…”

Section: Diabetesmentioning

confidence: 99%

Stroke and kidney transplantation

Abreo

Kataria

Amrutkar

et al. 2023

Current Opinion in Organ Transplantation

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Purpose of review This review will focus on the epidemiological data, risk factors, and management of stroke before and after kidney transplant. Stroke is highly prevalent in waitlisted patients as well as kidney transplant recipients and is associated with impaired transplant outcomes. Multiple traditional, nontraditional, and transplanted risk factors increase the risk of stroke. Recent findings Although the risk of stroke is reduced after kidney transplantation compared with remaining on dialysis, the morbidity and mortality from stroke after transplantation remain significant. Summary Early screening for risk factors before and after a kidney transplant and following the Kidney Disease Improving Global Outcomes (KDIGO) management guidelines could minimize the incidence of stroke and transplant outcomes.

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Recent advances in new-onset diabetes mellitus after kidney transplantation

Cited by 9 publications

References 99 publications

Agonistas do Receptor de Peptídeo Semelhante ao Glucagon-1 em Transplantados Renais - Estudo Retrospectivo de um Centro Hospitalar

Agonistas do Receptor de Peptídeo Semelhante ao Glucagon-1 em Transplantados Renais - Estudo Retrospectivo de um Centro Hospitalar

Fresh insights into glucocorticoid-induced diabetes mellitus and new therapeutic directions

Stroke and kidney transplantation

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