Associations of obesity with antidiabetic medication use after living kidney donation: An analysis of linked national registry and pharmacy fill records

Abstract

We examined a novel linkage of national US donor registry data with records from a pharmacy claims warehouse (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) to examine associations (adjusted hazard ratio, LCL aHR UCL ) of post-donation fills of antidiabetic medications (ADM, insulin or non-insulin agents) with body mass index (BMI) at donation and other demographic and clinical factors. In 28 515 living kidney donors (LKDs), incidence of ADM use at 9 years rose in a graded manner with higher baseline BMI: underweight, 0.9%; normal weight, 2.1%; overweight, 3.5%; obese, 8.5%. Obesity was associated with higher risk of ADM use compared with normal BMI (aHR, 3.36 4.59 6.27 ). Metformin was the most commonly used ADM and was filled more often by obese than by normal weight donors (9-year incidence, 6.87% vs 1.85%, aHR, 3.55 5.00 7.04 ). Insulin use was uncommon and did not differ significantly by BMI. Among a subgroup with BMI data at the 1-year post-donation anniversary (n = 19 528), compared with stable BMI, BMI increase >0.5 kg/m 2 by year 1 was associated with increased risk of subsequent ADM use (aHR, 1.03 1.48 2.14, P = .04). While this study did not assess the impact of donation on the development of obesity, these data support that among LKD, obesity is a strong correlate of ADM use.

Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: A systematic review

“…When relatedness was incorporated into the analysis, compared to White donors, the risk of post‐donation type 2 DM in Hispanic donors was numerically greater but was not statistically significant 36 . When OPTN data were linked to a US pharmaceutical claims data warehouse, there was no significant difference in the risk of taking any anti‐diabetic medications in Hispanic compared to White donors, but Hispanic donors were more likely to start insulin therapy 32 . Using Medicare claims, at 5 years post‐donation, Hispanic donors had twice the relative risk of post‐donation DM compared to White donors 35 .…”

“…We retained 15 articles meeting inclusion criteria. From hand-searching bibliographies of the final 15 articles and 3 review papers, [21][22][23] we obtained 3 additional articles resulting in the final inclusion of 18 studies 19,20,24,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] (Figure 1, Table 1). The results in the tables highlight outcomes evaluated among Hispanic donors and respective comparison groups (Tables 2 and 3).…”

“…36 When OPTN data were linked to a US pharmaceutical claims data warehouse, there was no significant difference in the risk of taking any anti-diabetic medications in Hispanic compared to White donors, but Hispanic donors were more likely to start insulin therapy. 32 Using Medicare claims, at 5 years post-donation, Hispanic donors had twice the relative risk of post-donation DM compared to White donors. 35 Regarding early post-donation outcomes, relative to White donors, Hispanic donors were more likely to develop post-donation DM within the first two years (aHR: 2.45 [95% CI 1.14-5.26]).…”

Weight trends in living kidney donors suggest predonation counselling alone lacks a sustainable effect on weight loss: a single centre cohort study

“…Weight gain in donors, just in line with the general population, is associated with new‐onset diagnosis of hypertension and diabetes [17,23]. In our donor population, the low incidence of diabetes, proteinuria or increased need for anti‐hypertensive medications could be attributed to donor selection bias, where class II and III obese individuals would not be considered for donation and alternative donors would be sought, with very few exceptions.…”

Cambios en el perfil clínico, tiempo de ingreso y variables relativas a complicaciones y función renal en donantes y receptores del trasplante de donante vivo de riñón

“…Otro estudio identificó asociaciones de IMC más alto en la donación con aumentos graduales en la incidencia de la necesidad de medicación para la diabetes mellitus después de la donación , un posible mediador del riesgo de ERC posterior a la donación (115).…”