Analysis of Posttransplant Diabetes Mellitus Prevalence in a Population of Kidney Transplant Recipients

doi:10.1016/j.transproceed.2008.05.045

Transplantation Proceedings

Volume 40, Issue 6, July–August 2008, Pages 1888-1890

https://doi.org/10.1016/j.transproceed.2008.05.045 Get rights and content

Abstract

Aim

The onset of posttransplant diabetes mellitus (PTDM) among kidney recipients is associated with an increased risk of graft failure and death. Minimizing the risk of PTDM is a priority for long-term improvement in survival rates. We sought to evaluate the prevalence of PTDM and impaired fasting glucose (IFG) among a population of kidney transplant recipients to identify the risk factors and to evaluate graft and patient survivals.

Methods

We analyzed 250 consecutive Caucasian patients who received kidney allografts in our center between May 2000 and December 2005, with a median follow-up of 32 months (range, 1–78 months).

Results

We observed altered glucose metabolism in 17% of patients; specifically, the prevalences of PTDM and IFG were 12.2% and 4.8%, respectively. Patients who developed PTDM or IFG were overweight (BMI, 26.4 ± 3.4 and 28.1 ± 3.4 kg/m², respectively), whereas the normal glucose (NG) group's BMI was 23.8 ± 3.5 kg/m² (P = .002 and P = .004, respectively). Prevalence of acute rejection was higher in the PTDM and IFG patients compared with the NG patients (60.7%, 63.6%, and 32.1%, respectively; P = .006; P < .04), while no difference was observed in terms of graft and patient overall survival.

Conclusion

In our series of patients, we showed that being overweight represents a major risk factor for the development of PTDM, which results in an increased acute rejection rate. These results confirmed the importance of appropriate weight control among patients undergoing kidney transplantation, which should also be strictly monitored for all risk factors associated with the development of impaired glucose metabolism.

Section snippets

Materials and Methods

We collected data from 250 patients who received a kidney allograft between May 2000 and December 2005. Diabetes and IFG were diagnosed in accordance with American Diabetes Association (ADA) guidelines⁵: diabetes as a fasting blood glucose level ≥126 mg/dL twice or a random blood glucose ≥200 mg/dL versus IFG as a blood glucose level between 110 and 125 mg/dL without insulin or oral antidiabetic treatment. The OGTT criteria and impaired glucose tolerance were omitted because of lack of data

Results

Incidences of PTDM were diagnosed in 28 of 229 patients (12.2%), with 24 of 28 patients (86%) developing diabetes during the first year posttransplantation; IFG was diagnosed in 11 of 229 patients (5%).

Discussion

In our retrospective study we observed an alteration of glucose metabolism in 17% of patients; specifically, the prevalence of PTDM and IFG was 12.2% and 4.8%, respectively. The BMI at baseline seemed to be an important factor for the development of altered glucose metabolism: PTDM and IFG patients were more frequently overweight. These data confirmed that weight may be a risk factor for PTDM. Interestingly, we more frequently observed a positive family history for DM among PTDM patients.

References (5)

F. Vincenti et al.
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J. Hjelmesaeth et al.
The impact of early-diagnosed new-onset posttransplantation diabetes mellitus on survival and major cardiac events
Kidney Int
(2006)

There are more references available in the full text version of this article.

Cited by (30)

Adherence to Pharmacotherapy and Lifestyle Recommendations Among Hemodialyzed Patients and Kidney Transplant Recipients
2021, Journal of Renal Nutrition
Citation Excerpt :
Transplantation causes huge lifestyle changes, resulting in weight gain: good graft function eliminates the need for a strict diet recommended during chronic hemodialysis; the patient's appetite improves as uremic toxins are removed from the body, while glucocorticosteroid treatment also improves the appetite. This predisposes the patient to weight gain, which in turn increases the risk of posttransplant diabetes mellitus and arterial hypertension, which leads to cardiovascular complications and potential graft loss.42,43 In the long-term follow-up, overweight and obese KTx recipients present with worse graft function than those with normal body weight.
Success in treatment with hemodialysis (HD) and kidney transplantation (KTx) requires good adherence. The objective of this study was to evaluate adherence to pharmacotherapy and health recommendations among HD and KTx patients using subjective and objective measures.
Two hundred thirty-nine enrolled patients, with 132 KTx (39F, 93M) and 107 HD (48F, 59M) completed a questionnaire regarding over-the-counter (OTC) medications and dietary supplements (DS), adherence to pharmacotherapy, lifestyle recommendations, and self-evaluation of knowledge on them. The surveys were supplemented with objective data from patients’ medical records, including interdialytic weight gain and laboratory parameters.
About 42.1% HD and 39.4% KTx patients reported using OTC medications without medical consultation (P = .677); 43.9% HD and 31.1% KTx used DS (P = .040); more HD than KTx failed to notify a doctor about it (52.2% vs. 21.4%; P < .001). More HD patients skipped medication doses (33.6% vs. 9.7%; P < .001). About 40.2% HD and 20.5% KTx patients drank alcohol (P < .001), 22.4% HD and 10.5% KTx smoked (P = .013). About 46.7% HD and 66.4% KTx patients limited their caloric intake (P = .002), 73.8% HD and 84.9% KTx limited their salt intake (P = .030). HD patients drank 1.17 ± 0.57 L of fluids daily and KTx drank 2.51 ± 0.67 L (P < .001). In HD patients, interdialytic weight gains positively correlated with dialysis vintage (R = 0.26, P = .02) and fluid (R = 0.28, P = .011) but not salt intake (P = .307). The variability of trough levels of calcineurin inhibitors was unrelated to use of DS or OTC medications. KTx rated their knowledge on recommendations higher compared with HD (mean score 4.0 ± 1.0 vs. 3.7 ± 1.0, P = .040).
KTx recipients exhibit better adherence and rate their knowledge on recommendations higher than HD patients.
Kidney transplantation after sleeve gastrectomy in the morbidly obese candidate: results of a 2-year experience
2020, Surgery for Obesity and Related Diseases
Morbid obesity serves as a barrier to kidney transplantation (KT) due to potential suboptimal posttransplant outcomes. Laparoscopic sleeve gastrectomy (LSG) has previously been shown to improve transplant eligibility through weight loss.
We aimed to examine the role LSG plays in improving patient outcomes postrenal transplantation, including possible impact on new-onset diabetes after transplant (NODAT).
University Hospital.
A single-center analysis was performed identifying all patients who underwent KT after LSG from 2011 to 2017 (n = 41). Exclusion criteria included type I diabetes and previous pancreas transplantation. NODAT was defined as a new insulin requirement after KT. Delayed graft function was defined as need for dialysis within the first week after KT. Mean posttransplant follow-up period was 22 months.
Forty-one patients underwent KT after LSG after median time of 16 months. Median age of postLSG patients undergoing KT was 56.0 years at time of KT. Average body mass index decreased by 9 from the time of LSG to KT, and no patients regained weight at 1-year follow-up. After LSG, the number of patients with hypertension (85.4% versus 48.5%) and the number of antihypertensive medications used decreased significantly (1.6 versus .6) at time of KT (P < .001 each). At 1-year follow-up, the improvement in hypertension persisted (51.2% versus 48.5%, P = nonsignificant). The average insulin regimen decreased from 33.0 ± 51.6 to 11.7 ± 21.5 units at KT (P < .001). This improvement also persisted at 1-year follow-up (11.9 versus 11.7 units, P = nonsignificant). Zero patients suffered NODAT over the follow-up period (versus institutional rate of NODAT at 15.8%). One patient developed delayed graft function (2.4%, versus institutional rate of 13.3%). After 1 year postKT, there was 1 graft loss (2.4%) and no mortality.
This is the largest reported series of KT after planned LSG in morbidly obese patients. Our results confirm excellent posttransplant outcomes among patients who otherwise would have been denied KT eligibility.
The incidence of new onset diabetes after transplantation and related factors: Single center experience
2017, Nefrologia
Citation Excerpt :
In our study, older age was established as a risk factor of PTDM. Obesity represents a modifiable risk factor and has been shown to be associated with the development of PTDM in many studies.24,26,27 Analysis of the USRDS database revealed that obesity, defined as a BMI of >30 kg/m2 is one of the strongest risk factors for PTDM (relative risk (RR) of 1.73, p < 0.0001).24,26
New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication and is considered a risk factor for patients undergoing renal transplant. The aim of this study was to evaluate the incidence and developing duration of new-onset diabetes after transplant (NODAT) and influencing factors.
All patients’ data was investigated retrospectively. Diabetics, follow-up period < 6 months, age < 18years were excluded. Demographic, clinical and laboratory data was recorded. Patients were divided into two groups: with/without NODAT. NODAT group was divided into four subgroups according to the time of developing NODAT, which were 0–3, 3–6, 6–12 and 12 months later. Two groups were compared, to investigate the incidence of NODAT and risk factors associated with the occurrence of NODAT.
We retrospectively analyzed the records of 570 patients, of which 420 patients were included. Seventy (16.6%) patients had NODAT (36 female, mean age 51.7 ± 8.2 years, mean follow-up 41.6 ± 21.5 months), 52.8% of patients developed NODAT within the first three months of being diagnosed. 350 patients (116 female, mean age 43.2 ± 12.5 years, mean follow-up 41.6 ± 21.5 months) were without NODAT. The incidence of impaired fasting glucose (IFG) during the first week after transplant was found to be higher in the patients with NODAT (p < 0.001). There was positive correlation between NODAT and older age, obesity, family history of diabetes, presence of IFG, fasting plasma glucose, total and LDL-cholesterol, triglycerides, parathormone. Old age, obesity, presence of IFG, pretransplant hypertriglyceridemia and hyperparathyroidism were predictors of development of NODAT.
Incidence of NODAT, especially the first six months, was high. All patients should be screened for IFG within the first week. Patients with dyslipidemia, elderly and obese patients should be closely monitored for the risk of development of NODAT.
La diabetes postrasplante de nueva aparición (NODAT, new-onset diabetes after transplantation) es una complicación metabólica frecuente y se considera un factor de riesgo para los pacientes a los que se ha realizado un trasplante renal. El objetivo de este estudio fue evaluar la incidencia y la duración del desarrollo de NODAT y los factores que influyen en ello.
Se estudiaron los datos de todos los pacientes de manera retrospectiva. Se excluyó a los diabéticos, a los pacientes con un período de seguimiento inferior a 6 meses y a aquellos con menos de 18 años. Se registraron los datos demográficos, clínicos y de laboratorio. Se dividió a los pacientes en 2 grupos: con/sin NODAT. El grupo con NODAT se dividió en 4 subgrupos de acuerdo con el momento en que desarrollaron NODAT, que fueron 0-3, 3-6, 6-12 y 12 meses más tarde. Se compararon los 2 grupos para analizar la incidencia de NODAT y los factores de riesgo asociados con la aparición de NODAT.
Se analizaron retrospectivamente los registros de 570 pacientes, de los cuales se incluyó a 420 pacientes. Un total de 70 pacientes (16,6%) presentaron NODAT (36 mujeres, con media de edad de 51,7 ± 8,2 años y un seguimiento medio de 41,6 ± 21,5 meses). El 52,8% de los pacientes desarrollaron NODAT durante los 3 primeros meses tras el diagnóstico. Otros 350 pacientes (116 mujeres, con una media de edad de 43,2 ± 12,5 años y un seguimiento medio de 41,6 ± 21,5 meses) no presentaron NODAT. Se encontró que la incidencia de la alteración de la glucemia en ayunas (IFG, impaired fasting glucose) durante la primera semana después del trasplante fue mayor en los pacientes con NODAT (p < 0,001). Hubo correlación positiva entre NODAT y edad avanzada, obesidad, antecedentes familiares de diabetes, IFG, glucemia plasmática en ayunas, colesterol total y colesterol-LDL, triglicéridos y hormona paratiroidea. Edad avanzada, obesidad, IFG, hipertrigliceridemia e hiperparatiroidismo pretrasplante fueron factores predisponentes a desarrollar NODAT.
La incidencia de NODAT, especialmente durante los primeros 6 meses, fue alta. Se tuvo que examinar a todos los pacientes en busca de IFG durante la primera semana. Se debe controlar estrechamente el riesgo de desarrollar NODAT en pacientes con dislipidemia, ancianos y obesos.
Pretransplantation Risk Factors Associated With New-onset Diabetes After Living-donor Kidney Transplantation
2016, Transplantation Proceedings
Citation Excerpt :
Obesity and overweight conditions were both considered to be risk factors for NODAT [11,12]. Obesity, which was associated with peripheral insulin resistance, had been shown to be associated with the development of NODAT [13]. Moreover, adipose tissue was implicated in the secretion of adipokines which played a role in the incidence of NODAT [14].
Mid-term date of kidney recipients with new-onset diabetes mellitus after transplantation (NODAT) was poor. We made a retrospective study of 397 patients who had living-donor kidney transplantation between January 2007 and May 2010 in our center. Pretransplantation risk factors for NODAT were identified by univariate and multivariate analyses. The mean follow-up was 53.5 ± 10.4 months. The prevalence of NODAT was 9.3%. Univariate analyses found the mean recipient age ≥40 years, body mass index (BMI) ≥24 kg/m², family history of diabetes, fasting blood glucose (FBG) ≥5.6 mmol/L, 2-hour plasma glucose ≥7.8 mmol/L, and tacrolimus were risk factors for NODAT. In logistic regression, BMI ≥24 kg/m² (odds ratio [OR]: 4.14, confidence interval [CI]: 2.02 ∼ 8.49, P < .001), family history of diabetes (OR: 2.62, CI: 1.09 ∼ 6.34, P = .032), and FBG ≥5.6 mmol/L (OR: 3.21, CI: 1.52 ∼ 6.79, P = .002) were independent risk factors. In conclusion, the mid-term prevalence of NODAT in Chinese renal recipients was low (9.3%). Pretransplantation independent risk factors were BMI ≥24 kg/m², family history of diabetes, and FBG ≥5.6 mmol/L; thus identifying which factors might help to prevent NODAT.
Post-transplantation weight gain: Prevalence and the impact of steroid-free therapy
2014, Transplantation Proceedings
Weight gain after renal transplantation has a multifactorial etiology, which can be associated with complications such as hypertension, dyslipidemia and diabetes, with a probable impact on cardiovascular morbidity and mortality post-transplantation.
The objectives of this study were to investigate the prevalence of weight gain and obesity post-transplantation among renal recipients of a hospital and to evaluate the impact of immunosuppressive therapy without steroids.
We have evaluated all patients who had kidney transplantations performed between January 2005 and December 2009 at General Hospital of Fortaleza, who were older than 18 years of age and had at least 12 months of follow-up post-transplantation. Overweight was defined as body mass index (BMI) between 25 and 30 kg/m² and obesity >30 kg/m². The association between weight gain and the following variables was investigated: age and gender of the recipient and the donor, donor type, steroid use, presence of systemic arterial hypertension (SAH) and diabetes mellitus, creatinine, glucose, cholesterol, and triglycerides.
The study population included 203 recipients; 59.5% were males, their mean age systemic arterial hypertension (SAH) was 37 years, and 64.2% had deceased donors. In regard to immunosuppression, 41.3% made use of steroids. After 36 months of follow-up, the average weight gain was 6.6 kg in relation to the first month post-transplantation. Among the variables studied, the recipient's younger age and female gender, the younger donor, and the creatinine level were associated with greater weight gain after 36 months of transplantation.
The percentage of weight gain was on average 9% after 36 months post-transplantation, although the prevalence of overweight and obesity increased significantly in the same period. The use of steroid therapy had no impact on the percentage of weight gain post-transplantation, and association was observed only between the younger age and the female gender of the recipient, the younger donor age, and the creatinine level with the highest weight gain post-transplantation.
Adiposity and cardiovascular disease risk factors in renal transplant recipients: Are there differences between sexes?
2013, Nutrition
The aim of this study was to evaluate high body adiposity and cardiovascular disease (CVD) risk factors prevalence, in renal transplant recipients (RTR), comparing men with women.
In this retrospective cross-sectional study, 102 patients (55 men) who were 49 ± 1.2 y and 114.3 ± 9 mo post-transplant (post-tx) were evaluated. Pretransplant (pre-tx) period data and weight gain during the first year post-tx were obtained from patient charts and post-tx data were collected during a routine visit at nephrology clinic. Body mass index (BMI) ≥ 25 kg/m² defined overweight and BMI ≥ 30 kg/m² defined obesity.
Pre-tx overweight prevalence was low and similar between men and women (26%), whereas only women showed obesity (11%). Post-tx body weight increased significantly in the entire group, leading to an increase in overweight (to 38% in men and 51% in women) and obesity (to 11% in men and 23% in women) prevalence. Post-tx comparisons between men and women showed that women had higher (women versus men; P < 0.05) BMI values (26.7 ± 0.8 versus 24.7 ± 0.5 kg/m²), weight gain during first year post-tx (9.2 ± 1.1 versus 5.5 ± 1 kg), abdominal obesity (57% versus 23%) and diabetes (34% versus 16%) prevalence. The associations between adiposity and CVD risk factors showed that pre-tx overweight increased the risk for diabetes in post-tx; pos-tx high BMI and abdominal obesity increased the risk for metabolic syndrome; abdominal obesity increased the risk for dyslipidemia in women.
High body adiposity prevalence was high after transplantation and increased the risk for metabolic syndrome, an important CVD risk factor. Women showed higher total body adiposity values, abdominal obesity, and diabetes prevalence than men. Abdominal obesity increased the risk for dyslipidemia in women.

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Kidney transplantationComplication: Diabetes mellitusAnalysis of Posttransplant Diabetes Mellitus Prevalence in a Population of Kidney Transplant Recipients

Abstract

Aim

Methods

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Am J Transplant

Kidney Int

Kidney transplantation
Complication: Diabetes mellitus
Analysis of Posttransplant Diabetes Mellitus Prevalence in a Population of Kidney Transplant Recipients