Approach to the patient: Early post-renal transplant hyperglycemia.

Patients with diabetes experience better glycemic control in end-stage renal disease (ESRD), with resurgence of hyperglycemia after kidney transplant. Both patients with and without known diabetes are at risk of EPTH. Risk factors include elevated pre-transplant fasting glucose, diabetes, glucocorticoids, chronic infections, and post-transplant infections. We find that EPTH increases risk of re-hospitalizations from infections (CMV, possibly COVID-19), acute graft rejections, cardiovascular events and PTDM. It is essential, hence, to provide diabetes education to patients prior to discharge. Insulin remains the standard of care while inpatient. Close follow up after discharge is recommended for insulin adjustment. Some agents like dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists have shown promise. The tenuous kidney function in the early period post-transplant and lack of data limits the use of sodium-glucose co-transporter 2 (SGLT-2) inhibitors. There is a need for studies assessing non-insulin agents for EPTH to decrease risk of hypoglycemia associated with insulin and long-term complications of EPTH.