Prediabetes is a risk factor for cardiovascular disease following renal transplantation

Dı́az, Juan; Moreso, Francesc; Lauzurrica, Ricardo; Ibernon, Meritxel; Torres, Irene Silva; Ruiz, Roberto; Rodríguez-Rodríguez, Ana Elena; Mallén, Patricia Delgado; Bayés-Genís, Beatriz; Gaínza, Francisco J.; Osorio, J.M.; Osuna, Antonio; Domínguez, Rosa; Ruiz, Juan Carlos; Sosa, Alejandro Jiménez; Rinne, Ari; Miranda, Domingo Marrero; Macías, Manuel; Torres, Armando

doi:10.1016/j.kint.2019.06.026

Cited by 37 publications

(38 citation statements)

References 20 publications

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“…In an earlier analysis, the same group has also shown a very similar mortality association for PTDM (“manifest” and diagnosed by OGTT‐derived 2‐hour plasma glucose) and impaired glucose tolerance [3]. The fact that the risk associated with hyperglycemia extends from PTDM to prediabetes was reaffirmed in a study from Spain where impaired glucose tolerance plus impaired fasting glucose, as well as PTDM itself, diagnosed at 12‐months post‐transplant, were associated with cardiovascular events in kidney transplanted patients [31]. How and when to screen for hyperglycemia during the unstable post‐transplant phase [32,33], and the best way to identify patients at risk (previous recommendations 3 and 4) are therefore not trivial issues.…”

Section: Introductionmentioning

confidence: 93%

“…How and when to screen for hyperglycemia during the unstable post‐transplant phase [32,33], and the best way to identify patients at risk (previous recommendations 3 and 4) are therefore not trivial issues. However, the fact that there truly is an increased risk of mortality in kidney transplant recipients [34], especially if they have treated PTDM [35,36], and that this mortality risk is most likely due to cardiovascular causes [3‐5,31,37,38], is by now well established.…”

Section: Introductionmentioning

confidence: 99%

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Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

et al. 2020

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Summary Post‐transplant diabetes mellitus (PTDM) shows a relationship with risk factors including obesity and tacrolimus‐based immunosuppression, which decreases pancreatic insulin secretion. Several of the sodium–glucose‐linked transporter 2 inhibitors (SGLT2is) and glucagon‐like peptide 1 receptor agonists (GLP1‐RAs) dramatically improve outcomes of individuals with type 2 diabetes with and without chronic kidney disease, which is, as heart failure and atherosclerotic cardiovascular disease, differentially affected by both drug classes (presumably). Here, we discuss SGLT2is and GLP1‐RAs in context with other PTDM management strategies, including modification of immunosuppression, active lifestyle intervention, and early postoperative insulin administration. We also review recent studies with SGLT2is in PTDM, reporting their safety and antihyperglycemic efficacy, which is moderate to low, depending on kidney function. Finally, we reference retrospective case reports with GLP1‐RAs that have not brought forth major concerns, likely indicating that GLP1‐RAs are ideal for PTDM patients suffering from obesity. Although our article encompasses PTDM after solid organ transplantation in general, data from kidney transplant recipients constitute the largest proportion. The PTDM research community still requires data that treating and preventing PTDM will improve clinical conditions beyond hyperglycemia. We therefore suggest that it is time to collaborate, in testing novel antidiabetics among patients of all transplant disciplines.

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Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

et al. 2020

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“…In the same line, prediabetes has been recently associated with cardiovascular disease in renal transplantation. Porrini et al [89] performed a 8-year follow-up study of 600 kidney transplant recipients and observed that prediabetes and PTDM, compared to normal glucose tolerance, measured at 12 months post-transplantation, were both associated with a comparable 2-fold increased incidence of cardiovascular events. So, the full spectrum of post-transplant hyperglycaemia, prediabetes, and diabetes increase the risk for cardiovascular disease after transplantation.…”

Section: Consequences Of Prediabetes and Ptdm In Renal Transplant Recipientsmentioning

confidence: 99%

Post-Transplant Diabetes Mellitus and Prediabetes in Renal Transplant Recipients: An Update

Rodríguez-Rodríguez

Hornum

Donate‐Correa

et al. 2021

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Post-transplant diabetes mellitus (PTDM) is a frequent and relevant complication after renal transplantation: it affects 20–30% of renal transplant recipients and increases the risk for cardiovascular and infectious events. Thus, understanding pathogenesis of PTDM would help limiting its consequences. In this review, we analyse novel aspects of PTDM, based on studies of the last decade, such as the clinical evolution of PTDM, early and late, the reversibility rate, diagnostic criteria, risk factors, including pre-transplant metabolic syndrome and insulin resistance (IR) and the interaction between these factors and immunosuppressive medications. Also, we discuss novel pathogenic factors, in particular the role of β-cell function in an environment of IR and common pathways between pre-existing cell damage and tacrolimus-induced toxicity. The relevant role of prediabetes in the pathogenesis of PTDM and cardiovascular disease is also addressed. Finally, current evidence on PTDM treatment is discussed.

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“…While this risk may not be as high as in those with pre‐existing diabetes, it likely reflects the difference in cumulative exposure to glycaemia, or the presence of metabolic syndrome. In addition, pre‐diabetes has been suggested as a risk factor for the development of CVD in people with PTDM 19 …”

Section: Epidemiology Of Ptdmmentioning

confidence: 99%

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

et al. 2021

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Post‐transplant diabetes mellitus (PTDM) is common after solid organ transplantation (SOT) and associated with increased morbidity and mortality for allograft recipients. Despite the significant burden of disease, there is a paucity of literature with regards to detection, prevention and management. Evidence from the general population with diabetes may not be translatable to the unique context of SOT. In light of emerging clinical evidence and novel anti‐diabetic agents, there is an urgent need for updated guidance and recommendations in this high‐risk cohort. The Association of British Clinical Diabetologists (ABCD) and Renal Association (RA) Diabetic Kidney Disease Clinical Speciality Group has undertaken a systematic review and critical appraisal of the available evidence. Areas of focus are; (1) epidemiology, (2) pathogenesis, (3) detection, (4) management, (5) modification of immunosuppression, (6) prevention, and (7) PTDM in the non‐renal setting. Evidence‐graded recommendations are provided for the detection, management and prevention of PTDM, with suggested areas for future research and potential audit standards. The guidelines are endorsed by Diabetes UK, the British Transplantation Society and the Royal College of Physicians of London. The full guidelines are available freely online for the diabetes, renal and transplantation community using the link below. The aim of this review article is to introduce an abridged version of this new clinical guideline ( https://abcd.care/sites/abcd.care/files/site_uploads/Resources/Position-Papers/ABCD-RA%20PTDM%20v14.pdf).

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Prediabetes is a risk factor for cardiovascular disease following renal transplantation

Cited by 37 publications

References 20 publications

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

Post-Transplant Diabetes Mellitus and Prediabetes in Renal Transplant Recipients: An Update

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

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