Table 4. Open in new tab Noninsulin...

Noninsulin agent

Considerations for use in EPTH

Reference studies

Comments

Metformin

o Avoid with tenuous renal function

Not favored in EPTH

o Gastrointestinal upset

o Can rarely cause lactic acidosis in impaired renal function

Sulfonylurea

o Require dose adjustment with renal function, which varies in the early posttransplant period

Not favored in EPTH

o High risk of hypoglycemia

o Weight gain

GLP-1 RA

o Potential risk of acute kidney injury with higher dose

(83–85)

Need further studies for use in EPTH

o Cardiovascular benefit

o Weight loss

DPP-4 inhibitors

o Better HOMA-IR and HOMA-B compared to insulin

(86–91)

Favorable studies, need randomized controlled trials to compare glycemic control for EPTH

o Linagliptin does not require renal dose adjustment

SGLT2 inhibitors

o Avoidance with tenuous kidney function

(92)

Need further studies for use in EPTH

o Potential for causing dehydration

o Genitourinary infections

o Weight loss

o Blood pressure control

o Increased risk of volume depletion and ketoacidosis perioperatively

o Canagliflozin showed glycemic improvement at 6 months post transplant without significant adverse effects

Thiazolidinediones

o Potential for fluid retention

Not favored

o Slow onset of action in improving hyperglycemia

o Weight gain

o Increased risk for heart failure

Table 4.

Open in new tab

Noninsulin agents that could be used for management of early post–renal transplant hyperglycemia

Noninsulin agent	Considerations for use in EPTH	Reference studies	Comments
Metformin	o Avoid with tenuous renal function		Not favored in EPTH
	o Gastrointestinal upset
	o Can rarely cause lactic acidosis in impaired renal function
Sulfonylurea	o Require dose adjustment with renal function, which varies in the early posttransplant period		Not favored in EPTH
	o High risk of hypoglycemia
	o Weight gain
GLP-1 RA	o Potential risk of acute kidney injury with higher dose	(83–85)	Need further studies for use in EPTH
	o Cardiovascular benefit
	o Weight loss
DPP-4 inhibitors	o Better HOMA-IR and HOMA-B compared to insulin	(86–91)	Favorable studies, need randomized controlled trials to compare glycemic control for EPTH
	o Linagliptin does not require renal dose adjustment
SGLT2 inhibitors	o Avoidance with tenuous kidney function	(92)	Need further studies for use in EPTH
	o Potential for causing dehydration
	o Genitourinary infections
	o Weight loss
	o Blood pressure control
	o Increased risk of volume depletion and ketoacidosis perioperatively
	o Canagliflozin showed glycemic improvement at 6 months post transplant without significant adverse effects
Thiazolidinediones	o Potential for fluid retention		Not favored
	o Slow onset of action in improving hyperglycemia
	o Weight gain
	o Increased risk for heart failure

Noninsulin agent	Considerations for use in EPTH	Reference studies	Comments
Metformin	o Avoid with tenuous renal function		Not favored in EPTH
	o Gastrointestinal upset
	o Can rarely cause lactic acidosis in impaired renal function
Sulfonylurea	o Require dose adjustment with renal function, which varies in the early posttransplant period		Not favored in EPTH
	o High risk of hypoglycemia
	o Weight gain
GLP-1 RA	o Potential risk of acute kidney injury with higher dose	(83–85)	Need further studies for use in EPTH
	o Cardiovascular benefit
	o Weight loss
DPP-4 inhibitors	o Better HOMA-IR and HOMA-B compared to insulin	(86–91)	Favorable studies, need randomized controlled trials to compare glycemic control for EPTH
	o Linagliptin does not require renal dose adjustment
SGLT2 inhibitors	o Avoidance with tenuous kidney function	(92)	Need further studies for use in EPTH
	o Potential for causing dehydration
	o Genitourinary infections
	o Weight loss
	o Blood pressure control
	o Increased risk of volume depletion and ketoacidosis perioperatively
	o Canagliflozin showed glycemic improvement at 6 months post transplant without significant adverse effects
Thiazolidinediones	o Potential for fluid retention		Not favored
	o Slow onset of action in improving hyperglycemia
	o Weight gain
	o Increased risk for heart failure

Abbreviations: DPP-4, dipeptidyl peptidase-4; EPTH, early post–renal transplant hyperglycemia; GLP-1 RA, glucagon-like peptide-1 receptor agonist; HOMA-B, homeostatic model assessment of β-cell function; HOMA-IR, homeostatic model assessment of insulin resistance; SGLT2, sodium-glucose cotransporter-2.

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