Preventing and managing hyperglycemia in kidney transplant patients.
OBJECTIVE
New onset diabetes after kidney transplantation (NODAT) remains a common complication after transplantation and is associated with significant morbidity and mortality. The review will examine recent advances in our knowledge of this metabolic disorder and speculate upon future development.


RESULTS
Research continues to broaden the horizon of existing and emerging risk factors that contribute to development of NODAT. Attempts to use this knowledge to develop quantitative risk scoring composites have been made, utilizing either pretransplant or 1-year posttransplantation variables, with variable success. Reassuringly a number of clinical trials have been published, or are currently in progress, that utilize pharmacological intervention for both prevention and management of NODAT. These are both in the form of differential immunosuppressant regimens or use of antiglycemic agents. Upcoming results will prove crucial in developing a genuine evidence-base for NODAT management.


CONCLUSIONS
Rather than simple translation of data from the general to kidney transplant population, clinicians must appreciate that NODAT constitutes a distinct metabolic entity with unique pathophysiology. As such targeted strategies to prevent and manage NODAT require focused investigation to deal with this common complication.
Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, UK. sharif_adnan@hotmail.com
Adnan
A
Sharif
D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents