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

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.

Comparison of Autar scale and Wells criteria in DVT risk assessment by nurses in patients with lower extremity trauma.

BACKGROUND: Deep vein thrombosis (DVT) is a common and preventable complication in patients with lower extremity trauma. DVT prediction is considered to be necessary. PURPOSE: This study aimed to compare the Autar DVT risk assessment scale with modified Wells criteria in predicting DVT by nurses in patients with lower extremity trauma. METHODS: Patients with lower extremity trauma patients who met the requirements for this study were assessed by both the Autar and Wells tools for DVT risk assessment during the first 24 hours after their admission. Statistical analysis was performed using SPSS 18. RESULTS: There was a significant and direct statistical relationship between the results of risk assessment of these two tools based on Pearson correlation (r= 0.731, P<0.0001). Kappa coefficient between the two was 53%. Sensitivity and specificity of the Autar scale were 100% and 68%, respectively, which revealed a higher degree of sensitivity than that of the Wells criteria. CONCLUSION: Although the results of DVT prediction for the Autar scale and modified Wells criteria were consistent, the Autar DVT risk assessment scale showed higher sensitivity. Therefore, it is recommended that the Autar scale be used to achieve more precise DVT predictions.