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Diabetes Mellitus Following Renal Transplantation: Clinical and Pharmacological Considerations for the Elderly Patient

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Abstract

Post-transplant diabetes mellitus occurs in 30–50% of cases during the first year post-renal transplantation. It is associated with increased morbidity, mortality and healthcare costs. Risk factors include age and specific immunosuppression regimens. At the same time, renal transplantation is increasingly indicated in elderly (aged >65 years) patients as this proportion of older patients in the prevalent dialysis population has increased. The immune system and β cells undergo senescence and this impacts on the risk for developing post-transplant diabetes and our ability to prevent such development. It may, however, be possible to identify patients at risk of developing post-transplant diabetes, enabling treatment protocols that prevent or reduce the impact of post-transplant diabetes. Much work remains to be completed in this area and is facilitated by the growing base of knowledge regarding the pathophysiology of post-transplant diabetes. Should post-transplant diabetes develop, there are a range of treatment options available. There is increasing interest in using newer agents, although their safety and efficacy in transplant recipients remains to be conclusively established.

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References

  1. Bergrem HA, Valderhaug TG, Hartmann A, et al. Undiagnosed diabetes in kidney transplant candidates: a case-finding strategy. Clin J Am Soc Nephrol. 2010;5(4):616–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Sharif A, Hecking M, de Vries AP, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant. 2014;14(9):1992–2000.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Caillard S, Eprinchard L, Perrin P, et al. Incidence and risk factors of glucose metabolism disorders in kidney transplant recipients: role of systematic screening by oral glucose tolerance test. Transplantation. 2011;91(7):757–64.

    CAS  PubMed  Google Scholar 

  4. Hornum M, Jorgensen KA, Hansen JM, et al. New-onset diabetes mellitus after kidney transplantation in Denmark. Clin J Am Soc Nephrol. 2010;5(4):709–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Iida S, Ishida H, Tokumoto T, et al. New-onset diabetes after transplantation in tacrolimus-treated, living kidney transplantation: long-term impact and utility of the pre-transplant OGTT. Int Urol Nephrol. 2010;42(4):935–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Langsford D, Obeyesekere V, Vogrin S, et al. A prospective study of renal transplant recipients: a fall in insulin secretion underpins dysglycemia after renal transplantation. Transplant Direct. 2016;2(11):e107.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. ANZDATA Registry. 39th report, Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia. 2017. Available from: http://www.anzdata.org.au. Accessed 30 June 2017.

  8. UK Renal Registry. 18th annual report of the Renal Association. Nephron. 2016;132(Suppl. 1):69–98.

    Google Scholar 

  9. United States Renal Data System. 2016 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, 2016. Available from: http://www.usrds.org/adr.aspx. Accessed 30 June 2017.

  10. Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2015 annual data report. Available from: http://www.srtr.org/reports-tools/srtroptn-annual-data-report/. Accessed 30 June 2017.

  11. Stevens KK, Woo YM, Clancy M, et al. Deceased donor transplantation in the elderly: are we creating false hope? Nephrol Dial Transplant. 2011;26(7):2382–6.

    Article  PubMed  Google Scholar 

  12. Heldal K, Hartmann A, Grootendorst DC, et al. Benefit of kidney transplantation beyond 70 years of age. Nephrol Dial Transplant. 2010;25(5):1680–7.

    Article  PubMed  Google Scholar 

  13. Schold J, Srinivas TR, Sehgal AR, Meier-Kriesche HU. Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant. Clin J Am Soc Nephrol. 2009;4(7):1239–45.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rao PS, Merion RM, Ashby VB, et al. Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation. 2007;83(8):1069–74.

    Article  PubMed  Google Scholar 

  15. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725–30.

    Article  CAS  PubMed  Google Scholar 

  16. Oniscu GC, Brown H, Forsythe JL. Impact of cadaveric renal transplantation on survival in patients listed for transplantation. J Am Soc Nephrol. 2005;16(6):1859–65.

    Article  PubMed  Google Scholar 

  17. McDonald SP, Russ GR. Survival of recipients of cadaveric kidney transplants compared with those receiving dialysis treatment in Australia and New Zealand, 1991–2001. Nephrol Dial Transplant. 2002;17(12):2212–9.

    Article  PubMed  Google Scholar 

  18. Tonelli M, Wiebe N, Knoll G, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11(10):2093–109.

    Article  CAS  PubMed  Google Scholar 

  19. Gill JS, Schaeffner E, Chadban S, et al. Quantification of the early risk of death in elderly kidney transplant recipients. Am J Transplant. 2013;13(2):427–32.

    Article  CAS  PubMed  Google Scholar 

  20. Vincenti F, Friman S, Scheuermann E, et al. Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant. 2007;7(6):1506–14.

    Article  CAS  PubMed  Google Scholar 

  21. Prasad N, Gurjer D, Bhadauria D, et al. Is basiliximab induction, a novel risk factor for new onset diabetes after transplantation for living donor renal allograft recipients? Nephrology. 2014;19(4):244–50.

    Article  CAS  PubMed  Google Scholar 

  22. Valderhaug TG, Hjelmesaeth J, Hartmann A, et al. The association of early post-transplant glucose levels with long-term mortality. Diabetologia. 2011;54(6):1341–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Hjelmesaeth J, Hartmann A, Leivestad T, et al. The impact of early-diagnosed new-onset post-transplantation diabetes mellitus on survival and major cardiac events. Kidney Int. 2006;69(3):588–95.

    Article  CAS  PubMed  Google Scholar 

  24. Cosio FG, Kudva Y, van der Velde M, et al. New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. Kidney Int. 2005;67(6):2415–21.

    Article  PubMed  Google Scholar 

  25. Valderhaug TG, Hjelmesaeth J, Jenssen T, Roislien J, Leivestad T, Hartmann A. Early posttransplantation hyperglycemia in kidney transplant recipients is associated with overall long-term graft losses. Transplantation. 2012;94(7):714–20.

    Article  CAS  PubMed  Google Scholar 

  26. Heldal K, Hartmann A, Leivestad T, Foss A, Midtvedt K. Risk variables associated with the outcome of kidney recipients >70 years of age in the new millennium. Nephrol Dial Transplant. 2011;26(8):2706–11.

    Article  PubMed  Google Scholar 

  27. Shivaswamy V, Boerner B, Larsen J. Post-transplant diabetes mellitus: causes, treatment, and impact on outcomes. Endocr Rev. 2016;37(1):37–61.

    Article  CAS  PubMed  Google Scholar 

  28. Yates CJ, Fourlanos S, Colman PG, Cohney SJ. Screening for new-onset diabetes after kidney transplantation: limitations of fasting glucose and advantages of afternoon glucose and glycated hemoglobin. Transplantation. 2013;96(8):726–31.

    Article  CAS  PubMed  Google Scholar 

  29. Shabir S, Jham S, Harper L, et al. Validity of glycated haemoglobin to diagnose new onset diabetes after transplantation. Transpl Int. 2013;26(3):315–21.

    Article  CAS  PubMed  Google Scholar 

  30. Eide IA, Halden TA, Hartmann A, et al. Limitations of hemoglobin A1c for the diagnosis of posttransplant diabetes mellitus. Transplantation. 2015;99(3):629–35.

    Article  CAS  PubMed  Google Scholar 

  31. Cole EH, Johnston O, Rose CL, Gill JS. Impact of acute rejection and new-onset diabetes on long-term transplant graft and patient survival. Clin J Am Soc Nephrol. 2008;3(3):814–21.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Luan FL, Steffick DE, Ojo AO. New-onset diabetes mellitus in kidney transplant recipients discharged on steroid-free immunosuppression. Transplantation. 2011;91(3):334–41.

    Article  CAS  PubMed  Google Scholar 

  33. Silva HT, Yang HC, Meier-Kriesche HU, et al. Long-term follow-up of a phase III clinical trial comparing tacrolimus extended-release/MMF, tacrolimus/MMF, and cyclosporine/MMF in de novo kidney transplant recipients. Transplantation. 2014;97(6):636–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Pascual J, Royuela A, Galeano C, et al. Very early steroid withdrawal or complete avoidance for kidney transplant recipients: a systematic review. Nephrol Dial Transplant. 2012;27(2):825–32.

    Article  CAS  PubMed  Google Scholar 

  35. Woodle ES, First MR, Pirsch J, et al. Astellas Corticosteroid Withdrawal Study Group. A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy. Ann Surg. 2008;248(4):564–77.

    PubMed  Google Scholar 

  36. Lopez-Soler RI, Chan R, Martinolich J, et al. Early steroid withdrawal results in improved patient and graft survival and lower risk of post-transplant cardiovascular risk profiles: a single-center 10-year experience. Clin Transplant. 2017;31(2). doi:10.1111/ctr.12878 (epub 2017 Jan 24).

  37. Pirsch JD, Henning AK, First MR, et al. New-onset diabetes after transplantation: results from a double-blind early corticosteroid withdrawal trial. Am J Transplant. 2015;15(7):1982–90.

    Article  CAS  PubMed  Google Scholar 

  38. Johnston O, Rose CL, Webster AC, Gill JS. Sirolimus is associated with new-onset diabetes in kidney transplant recipients. J Am Soc Nephrol. 2008;19(7):1411–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Masson P, Henderson L, Chapman JR, et al. Belatacept for kidney transplant recipients. Cochrane Database Syst Rev. 2014;(11):CD010699.

  40. Montero N, Pascual J. Immunosuppression and post-transplant hyperglycemia. Curr Diabetes Rev. 2015;11(3):144–54.

    Article  CAS  PubMed  Google Scholar 

  41. Heit JJ, Apelqvist AA, Gu X, et al. Calcineurin/NFAT signalling regulates pancreatic beta-cell growth and function. Nature. 2006;443(7109):345–9.

    Article  CAS  PubMed  Google Scholar 

  42. Nagaraja P, Ravindran V, Morris-Stiff G, Baboolal K. Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation. Transpl Int. 2013;26(3):273–80.

    Article  CAS  PubMed  Google Scholar 

  43. Hecking M, Werzowa J, Haidinger M, et al. Novel views on new-onset diabetes after transplantation: development, prevention and treatment. Nephrol Dial Transplant. 2013;28(3):550–66.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Nam JH, Mun JI, Kim SI, et al. Beta-cell dysfunction rather than insulin resistance is the main contributing factor for the development of postrenal transplantation diabetes mellitus. Transplantation. 2001;71(10):1417–23.

    Article  CAS  PubMed  Google Scholar 

  45. Ohn JH, Kwak SH, Cho YM, et al. 10-year trajectory of β-cell function and insulin sensitivity in the development of type 2 diabetes: a community-based prospective cohort study. Lancet Diabetes Endocrinol. 2016;4(1):27–34.

    Article  CAS  PubMed  Google Scholar 

  46. Defronzo RA, Tripathy D, Schwenke DC, et al. Prediction of diabetes based on baseline metabolic characteristics in individuals at high risk. Diabetes Care. 2013;36(11):3607–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Bergman RN, Ader M, Huecking K, Van Citters G. Accurate assessment of beta-cell function: the hyperbolic correction. Diabetes. 2002;51(Suppl. 1):S212–20.

    Article  CAS  PubMed  Google Scholar 

  48. Helman A, Avrahami D, Klochendler A, et al. Effects of ageing and senescence on pancreatic β-cell function. Diabetes Obes Metab. 2016;18(Suppl. 1):58–62.

    Article  CAS  PubMed  Google Scholar 

  49. Suarez O, Pardo M, Gonzalez S, et al. Diabetes mellitus and renal transplantation in adults: is there enough evidence for diagnosis, treatment, and prevention of new-onset diabetes after renal transplantation? Transplant Proc. 2014;46(9):3015–20.

    Article  CAS  PubMed  Google Scholar 

  50. Madziarska K, Weyde W, Krajewska M, et al. The increased risk of post-transplant diabetes mellitus in peritoneal dialysis-treated kidney allograft recipients. Nephrol Dial Transplant. 2011;26(4):1396–401.

    Article  PubMed  Google Scholar 

  51. Chakkera HA, Weil EJ, Swanson CM, et al. Pretransplant risk score for new-onset diabetes after kidney transplantation. Diabetes Care. 2011;34(10):2141–5.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Tokodai K, Amada N, Haga I, Takayama T, Nakamura A. The 5-time point oral glucose tolerance test as a predictor of new-onset diabetes after kidney transplantation. Diabetes Res Clin Pract. 2014;103(2):298–303.

    Article  CAS  PubMed  Google Scholar 

  53. Heldal K, Midtvedt K. Managing transplant rejection in the elderly: the benefits of less aggressive immunosuppressive regimens. Drugs Aging. 2013;30(7):459–66.

    Article  CAS  PubMed  Google Scholar 

  54. Krenzien F, ElKhal A, Quante M, et al. A rationale for age-adapted immunosuppression in organ transplantation. Transplantation. 2015;99(11):2258–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. McKay D, Jameson J. Kidney transplantation and the ageing immune system. Nat Rev Nephrol. 2012;8(12):700–8.

    Article  CAS  PubMed  Google Scholar 

  56. Fulop T, Larbi A, Witkowski JM, Kotb R, Hirokawa K, Pawelec G. Immunosenescence and cancer. Crit Rev Oncog. 2013;18(6):489–513.

    Article  PubMed  Google Scholar 

  57. Weinberger B, Grubeck-Loebenstein B. Vaccines for the elderly. Clin Microbiol Infect. 2012;18(Suppl. 5):100–8.

    Article  CAS  PubMed  Google Scholar 

  58. Noeldeke J, Fabrizii V, Arbogast H, et al. Prospective age-matching in elderly kidney transplant recipients: a 5-year analysis of the Eurotransplant Senior Program. Transplantation. 2006;82(1):141.

    Article  Google Scholar 

  59. Tullius SG, Milford E. Kidney allocation and the aging immune response. N Engl J Med. 2011;364(14):1369–70.

    Article  PubMed  Google Scholar 

  60. Heldal K, Hartmann A, Leivestad T, et al. Clinical outcomes in elderly kidney transplant recipients are related to acute rejection episodes rather than pretransplant comorbidity. Transplantation. 2009;87(7):1045–51.

    Article  PubMed  Google Scholar 

  61. Hecking M, Haidinger M, Doller D, et al. Early basal insulin therapy decreases new-onset diabetes after renal transplantation. J Am Soc Nephrol. 2012;23(4):739–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Hermayer KL, Egidi MF, Finch NJ, et al. A randomized controlled trial to evaluate the effect of glycemic control on renal transplantation outcomes. J Clin Endocrinol Metab. 2012;97(12):4399–406.

    Article  CAS  PubMed  Google Scholar 

  63. Wallia A, Schmidt K, Oakes DJ, et al. Glycemic control reduces infections in post-liver transplant patients: results of a prospective, randomized study. J Clin Endocrinol Metab. 2017;102(2):451–9.

    PubMed  Google Scholar 

  64. Aloi JA, Mulla C, Ullal J, Lieb DC. Improvement in inpatient glycemic care: pathways to quality. Curr Diab Rep. 2015;15(4):18.

    Article  PubMed  Google Scholar 

  65. Lipska KJ, Krumholz H, Soones T, Lee SJ. Polypharmacy in the aging patient: a review of glycemic control in older adults with type 2 diabetes. JAMA. 2016;315(10):1034–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. LaFranca JA, Ijermans JNM, Betjes MGH, Dor FJMF. Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Med. 2015;13:111.

    Article  PubMed  PubMed Central  Google Scholar 

  67. von During ME, Jenssen T, Bollerslev J, et al. Visceral fat is better related to impaired glucose metabolism than body mass index after kidney transplantation. Transpl Int. 2015;28(10):1162–71.

    Article  Google Scholar 

  68. Shah T, Kasravi A, Huang E, et al. Risk factors for development of new-onset diabetes mellitus after kidney transplantation. Transplantation. 2006;82(12):1673–6.

    Article  PubMed  Google Scholar 

  69. von During ME, Jenssen T, Bollerslev J, Asberg A, Godang K, Hartmann A. Visceral fat is strongly associated with post-transplant diabetes mellitus and glucose metabolism 1 year after kidney transplantation. Clin Transplant. 2017;31(1). doi:10.1111/ctr.12869 (epub 2016 Dec 15).

  70. Ryan KJ, Casas JM, Mash LE, et al. The effect of intensive nutrition interventions on weight gain after kidney transplantation: protocol of a randomised controlled trial. BMC Nephrol. 2014;15:148.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Collins M, Plank L, Ryan K, et al. The INTENT trial: the effect of intensive nutrition interventions on weight gain after kidney transplantation: a randomized controlled trial. Perth: Asian Pacific Society of Nephrology; 2016.

    Google Scholar 

  72. Painter PL, Hector L, Ray K, et al. A randomized trial of exercise training after renal transplantation. Transplantation. 2002;74(1):42–8.

    Article  PubMed  Google Scholar 

  73. Didsbury M, McGee RG, Tong A, et al. Exercise training in solid organ transplant recipients: a systematic review and meta-analysis. Transplantation. 2013;95(5):679–87.

    Article  CAS  PubMed  Google Scholar 

  74. Lo C, Jun M, Badve SV, et al. Glucose-lowering agents for treating pre-existing and new-onset diabetes in kidney transplant recipients. Cochrane Database Syst Rev. 2017;(2):CD009966.

  75. Kurian B, Joshi R, Helmuth A. Effectiveness and long-term safety of thiazolidinediones and metformin in renal transplant recipients. Endocr Pract. 2008;14(8):979–84.

    Article  PubMed  Google Scholar 

  76. Sharif A. Should metformin be our antiglycemic agent of choice post-transplantation? Am J Transplant. 2011;11(7):1376–81.

    Article  CAS  PubMed  Google Scholar 

  77. Hung AM, Roumie CL, Greevy RA, et al. Kidney function decline in metformin versus sulfonylurea initiators: assessment of time-dependent contribution of weight, blood pressure, and glycemic control. Pharmacoepidemiol Drug Saf. 2013;22(6):623–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Currie CJ, Poole CD, Gale EA. The influence of glucose-lowering therapies on cancer risk in type 2 diabetes. Diabetologia. 2009;52(9):1766–77.

    Article  CAS  PubMed  Google Scholar 

  79. Lalau JD, Arnouts P, Sharif A, De Broe ME. Metformin and other antidiabetic agents in renal failure patients. Kidney Int. 2015;87(2):308–22.

    Article  CAS  PubMed  Google Scholar 

  80. Stephen J, Anderson-Haag TL, Gustafson S, et al. Metformin use in kidney transplant recipients in the United States: an observational study. Am J Nephrol. 2014;40(6):546–53.

    Article  CAS  PubMed  Google Scholar 

  81. Tuerk TR, Bandur S, Nuernberger J, et al. Gliquidone therapy of new-onset diabetes mellitus after kidney transplantation. Clin Nephrol. 2008;70(1):26–32.

    Article  CAS  PubMed  Google Scholar 

  82. Dormandy JA, Charbonnel B, Eckland DJ, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet. 2005;366(9493):1279–89.

    Article  CAS  PubMed  Google Scholar 

  83. Schneider CA, Ferrannini E, Defronzo R, Schernthaner G, Yates J, Erdmann E. Effect of pioglitazone on cardiovascular outcome in diabetes and chronic kidney disease. J Am Soc Nephrol. 2008;19(1):182–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Saemann MD, Krebs M. Thiazolidinediones in the treatment of patients with Post-Transplant-Hyperglycemia or new-onset diabetes mellitus after renal transplantation (NODAT): a new therapeutic option? Wien Klin Wochenschr. 2010;122(7–8):198–202.

    Article  PubMed  Google Scholar 

  85. Kim JW, Yang JH, Park HS, et al. Rosiglitazone protects the pancreatic beta-cell death induced by cyclosporine A. Biochem Biophys Res Commun. 2009;390(3):763–8.

    Article  CAS  PubMed  Google Scholar 

  86. Voytovich MH, Simonsen C, Jenssen T, Hjelmesaeth J, Asberg A, Hartmann A. Short-term treatment with rosiglitazone improves glucose tolerance, insulin sensitivity and endothelial function in renal transplant recipients. Nephrol Dial Transplant. 2005;20(2):413–8.

    Article  CAS  PubMed  Google Scholar 

  87. Halden TA, Egeland EJ, Asberg A, et al. GLP-1 restores altered insulin and glucagon secretion in posttransplantation diabetes. Diabetes Care. 2016;39(4):617–24.

    Article  CAS  PubMed  Google Scholar 

  88. Boerner BP, Miles CD, Shivaswamy V. Efficacy and safety of sitagliptin for the treatment of new-onset diabetes after renal transplantation. Int J Endocrinol. 2014;2014:617638.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Lane JT, Odegaard DE, Haire CE, Collier DS, Wrenshall LE, Stevens RB. Sitagliptin therapy in kidney transplant recipients with new-onset diabetes after transplantation. Transplantation. 2011;92(10):e56–7.

    Article  PubMed  Google Scholar 

  90. Haidinger M, Werzowa J, Hecking M, et al. Efficacy and safety of vildagliptin in new-onset diabetes after kidney transplantation: a randomized, double-blind, placebo-controlled trial. Am J Transplant. 2014;14(1):115–23.

    Article  CAS  PubMed  Google Scholar 

  91. Sanyal D, Gupta S, Das P. A retrospective study evaluating efficacy and safety of linagliptin in treatment of NODAT (in renal transplant recipients) in a real world setting. Indian J Endocrinol Metab. 2013;17(Suppl. 1):S203–5.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.

    Article  CAS  PubMed  Google Scholar 

  93. Cherney D, Lund SS, Perkins BA, et al. The effect of sodium glucose cotransporter 2 inhibition with empagliflozin on microalbuminuria and macroalbuminuria in patients with type 2 diabetes. Diabetologia. 2016;59(9):1860–70.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Northern Health, 185 Cooper Street, Epping, Melbourne, VIC, 3075, Australia

    David Langsford

  2. University of Melbourne, Melbourne, VIC, Australia

    David Langsford

  3. St Vincent’s Health, Melbourne, VIC, Australia

    Adam Steinberg

  4. Deakin University, Geelong, VIC, Australia

    Karen M. Dwyer

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Correspondence to David Langsford.

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Langsford, D., Steinberg, A. & Dwyer, K.M. Diabetes Mellitus Following Renal Transplantation: Clinical and Pharmacological Considerations for the Elderly Patient. Drugs Aging 34, 589–601 (2017). https://doi.org/10.1007/s40266-017-0478-2

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