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Sodium-glucose co-transporter 2 inhibitors & glucagon-like peptide-1 receptor agonists, efficacy & safety in diabetic kidney transplant recipients

Mahmoud T, Yagan J, Hasan A, Gheith OA, Mostafa M, Rida S, et al.

Clin Transplant, 2023 Dec;37(12):e15144.
PMID: 37755118 DOI: 10.1111/ctr.15144

INTRODUCTION: Cardiovascular and renal complications define the outcomes of diabetic kidney transplant recipients (KTRs). The new diabetes medications have changed the management of diabetes. However, transplant physicians are still reluctant to use sodium-glucose cotransporter 2 inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor agonists (GLP-1RA) post kidney transplantation due to fear of drug related complications and lack of established guidelines.
PATIENTS AND METHODS: We collected 1-year follow-up data from records of 98 diabetic KTRs on SGLT2I, 41 on GLP- 1RA and 70 on standard-of-care medicines. Patients were more than 3 months post-transplant with a minimum estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73 m2 . Demographic data were similar except for a slightly lower HbA1c in the control group and higher albuminuria in SGLT2i group.
RESULTS: HbA1c dropped significantly by .4% in both SGLT2i and GLP-1RA compared to .05% in the control group. A significant decrease in BMI by .32 in SGLT2i and .34 in GLP-1RA was observed compared to an increase by .015 in control group. A tendency for better eGFR in study groups was observed but was non-significant except for the SGLT2i group with an eGFR above 90 (p = .0135). The usual dip in eGFR was observed in the SGLT2i group at 1-3 months. Albuminuria was significantly reduced in both study groups. Adverse events were minimal with comparable safety in all groups.
CONCLUSION: The use of SGLT2i and GLP-1RA appears to be effective and safe in diabetic KTRs with good outcomes. Randomized control trials are required to confirm these findings and establish guidelines.

Matched MeSH terms: Sodium/therapeutic use
Fulltext Rice starch low sodium oral rehydration solution (ORS) in infantile diarrhoea

Iyngkaran N, Yadav M

Med J Malaysia, 1995 Jun;50(2):141-4.
PMID: 7565183

The relative efficacy and incidence of hypernatremia of a rice starch based low sodium (sodium of 60 mmol/L) oral electrolyte solution was compared to the standard WHO oral rehydration solution (ORS; sodium 90 mmol/L) in 60 infants with non choleragenic acute diarrhoea. Both solutions were found to be equally effective in correcting dehydration as determined by the respective post hydration weight gain which was 150 +/- 175 gms in the rice starch low sodium ORS group and 164 +/- 125 gms in the standard WHO ORS group. However, the mean frequency of stools was greater and the duration of stay longer in the WHO ORS group compared to the rice starch low sodium group. There were 5 cases of hypernatremia in the WHO ORS group as opposed to only one in the rice starch low sodium ORS group. The present study shows that a rice starch low sodium ORS was as effective as the standard WHO ORS and had a lower incidence of hypernatremia in the fluid and electrolyte management of infants with non choleragenic diarrhoea.

Matched MeSH terms: Sodium/therapeutic use
Fulltext Prevention of Esophageal Strictures After Endoscopic Submucosal Dissection: A Promising Therapy Using Carboxymethyl Cellulose Sheets

Lua GW, Tang J, Liu F, Li ZS

Dig Dis Sci, 2016 06;61(6):1763-9.
PMID: 26809870 DOI: 10.1007/s10620-016-4034-4

BACKGROUND: Esophageal stricture is one of the serious adverse events following endoscopic submucosal dissection (ESD). However, optimum preventive techniques are still lacking.
AIMS: Our primary objective was to evaluate the incidence of post-ESD esophageal stricture with the application of carboxymethyl cellulose (CMC) sheets. Secondary objectives were to determine the number of sessions of endoscopic balloon dilatation (EBD) required to resolve post-ESD strictures and the incidence rate of peri-operative adverse events.
METHODS: This was a pilot, single-center, prospective study. Seven patients who had high risks of developing post-ESD esophageal stricture were enrolled into our study. CMC sheets were applied to the mucosal defects immediately after the completion of ESD. Patients were monitored and reviewed after ESD to detect any adverse events.
RESULTS: The incidence rate of post-operative stricture was 57 % (4/7 patients). Among patients who required EBD, the number of sessions performed was 2.8 ± 2.2. No serious post-operative adverse events were reported.
CONCLUSION: The use of CMC sheets appears to be a safe and effective prophylactic treatment for esophageal stricture following extensive ESD.

Matched MeSH terms: Carboxymethylcellulose Sodium/therapeutic use*

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