Continuous glucose monitoring in patients with chronic kidney disease on dialysis and with kidney transplantation

PURPOSE OF REVIEW: While adequate glycemic control is a cornerstone of mitigating the cardio-kidney-metabolic risk of end-stage kidney disease (ESKD) patients with diabetes, including those receiving dialysis or kidney transplantation, there are limitations in the accuracy and/or convenience of traditional glycemic metrics in these populations. This has led to growing interest in continuous glucose monitoring (CGM) as an automated, minimally-invasive digital technology in diabetic ESKD patients. RECENT FINDINGS: In the dialysis population, growing research shows that CGM is clinically reliable for use based on error grid analysis, although a wide range of mean absolute relative difference (MARD) values have been observed across cohorts and CGM devices. There are fewer studies of CGM in kidney transplant recipients (KTR's), which suggest reasonable analytical accuracy. While CGM has the potential to empower ESKD patients to participate actively in their disease management, broader adoption is limited by barriers at the healthcare system, financial, patient, and provider levels. SUMMARY: While emerging data support the clinical utility of CGM in ESKD, further research is needed to determine its efficacy and to inform the development and validation of decision support tools, educational interventions, and implementation strategies for broader uptake and integration into routine care in dialysis patients and KTR's.