Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation

Bee, Yong Mong; Tan, Hong Chang; Tay, Tunn Lin; Kee, Terence; Goh, Su-Yen; Kek, Peng Chin

doi:10.47102/annals-acadmedsg.v40n4p160

Cited by 32 publications

(9 citation statements)

References 32 publications

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“…This study found that the incidence of NODAT among kidney recipients was 38.3%, which is similar to that reported from Bahrain (33.5%), 26 and India (33.85%). 27 Nevertheless, it is more often higher than in other Arab countries, 28 29 30 Japan, 31 France, 32 the United States, 5 Russia, 33 Singapore, 34 and Canada. 35 The rates in these countries ranged between 7 and 24.2%.…”

Section: Discussionmentioning

confidence: 97%

Incidence and Risk Factors for the Development of New-Onset Diabetes after Kidney Transplantation

Elamouri

2023

Journal of Diabetes and Endocrine Practice

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Objective New-onset diabetes mellitus after transplantation (NODAT), also known as posttransplant diabetes mellitus, is a common complication after kidney transplantation. It is associated with an increased risk of graft failure and death. Therefore, minimizing the risk of NODAT is a priority after kidney transplantation. This study aimed to determine the incidence of NODAT, the risk factors for its development, and the therapeutic drugs used for its management. Patients and Methods This is an observational, retrospective study on kidney recipients who were followed up in our center in 2021. After excluding known diabetic patients, second transplant patients, and those with follow-up periods less than 6 months, 308 recipients were included in the study. Demographic, clinical, and laboratory data were collected from the patient records. The patients were categorized as diabetic or nondiabetic. Results All patients' mean age was 35.9±11.6 years (standard deviation). The male-to-female ratio was 2.13:1. The overall incidence of NODAT was 38.3%. The median time to NODAT diagnosis was 6 months. Patients older than 40 were more likely to develop NODAT (61.1%; p = 0.000). The prevalence of pretransplant body mass index (BMI) more than 25 was significantly higher (67.6%) in diabetic than among nondiabetic patients (p = 0.000). NODAT patients were more likely to have had a rejection episode (65 vs. 35% in nondiabetic patients; p = 0.011). A high trough level of calcineurin inhibitors carried a significant risk of NODAT development. Tacrolimus trough level more than or equal to 10 ng/mL had an odds ratio of 57.9 (95% confidence interval [CI] 7.689–1262.2; p = 0.0007) for the development of NODAT. Likewise, a cyclosporine-A trough level more than or equal to 150 ng/mL had an odds ratio of 100.7 (95% CI: 7.31–4293.5; p = 0.0028). Conclusion NODAT incidence was high in this study. Older age, high BMI, prior rejection episode, steroid dose, and high calcineurin inhibitors trough levels were significant risk factors for developing NODAT.

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Section: Discussionmentioning

confidence: 97%

Incidence and Risk Factors for the Development of New-Onset Diabetes after Kidney Transplantation

Elamouri

2023

Journal of Diabetes and Endocrine Practice

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“…Although none of the patients in this small series developed new diabetes after transplantation, previous local studies have reported a high incidence of diabetes (24.2%) at 5 years post-KT, which was associated with poorer graft and patient survival rates. 22 Thus, managing physicians should remain alert to the potential need to intensify diabetes treatment after transplant, even if patients experience improvements or normalization of blood glucose after bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

Bariatric Surgery in Kidney Transplant Candidates and Recipients: Experience at an Asian Center

Tan

Lee

Ganguly

et al. 2022

Journal of Obesity & Metabolic Syndrome

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Background: Kidney transplant (KT) candidates and recipients with obesity experience more frequent complications such as infection, poorer allograft outcomes, diabetes, and mortality, limiting their eligibility for transplantation. Bariatric surgery (BS) is not commonly performed among KT patients given concerns about immunosuppression absorption, wound healing, infections, and graft outcomes. Its role has not been described in an Asian setting.Methods: A retrospective review of patients who underwent BS at the largest KT center in Singapore from 2008 to 2020 was conducted. Metabolic outcomes, immunosuppression doses, graft outcomes, and mortality were studied.Results: Seven patients underwent BS and KT (4 underwent BS before KT, 3 underwent BS after KT; 4 underwent sleeve gastrectomy, 3 underwent gastric bypass). Mean total weight losses of 23.8% at 1 year and 18.6% at 5 years post-BS were achieved. Among the five patients with diabetes, glycemic control improved after BS. There were no deaths in the first 90 days or graft loss in the first year after KT and BS.Patients who underwent BS after KT had no significant changes in immunosuppression dose.Conclusions: BS can be safely performed in KT recipients and candidates and results in sustainable weight losses and improvements in metabolic comorbidities. Although no major complications were observed in our study, close monitoring of this complex group of patients is imperative.

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“…[33] Older age was observed as the risk factor for NODAT in populations of Brazil, [34] Turkey, [35] Portugal, [36] South Africa, [37] and Singapore. [38] Cosio et al [6] reported that there was 2.9 times increased risk in individuals undergoing renal transplantation, of age >45 years than younger patients. Gourishankar et al [39] have reported 1.5 times more risk for developing NODAT for every decade increase in life.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Biochemical Parameters, Kidney Function, and Long-term Outcome in Renal Transplant Recipients

Ahmad¹,

Kesiraju²,

Reddy³

et al. 2022

APJHS

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Background and Aims: New-onset of diabetes after transplantation (NODAT) is the most significant complications arising post-renal transplantation and affecting the long-term graft outcome and recipient survival. Assessment of renal function in kidney transplant recipients might help in understanding the better outcome of the graft and also the factors associated with NODAT. The present study was aimed to estimate the biochemical parameters, electrolytes, and minerals in the serum among renal transplant recipients and healthy controls (HC) and to evaluate the graft function, graft outcome and patient survival. Materials and Methods: Biochemical parameters (creatinine, urea, and uric acid), electrolytes (sodium, potassium, and chloride), and minerals (calcium and phosphorus) were estimated in serum by enzymatic method using commercially available kits in 100 HC, 80 NODAT, and 80 Non-NODAT subjects. The graft outcome was assessed by comparing serum creatinine levels and urinary creatinine clearance at 0 month and 60 months. The survival rate was evaluated by Kaplan-Meier survival curve. Results: The mean age was significantly higher in NODAT versus non-NODAT at P < 0.0009. Significant gender difference was observed in NODAT and non-NODAT versus HC at P < 0.0001. The levels of creatinine, urea, and uric acid were significantly more in NODAT versus HC at P < 0.0001, P < 0.0001, and P < 0.006. The mean levels of sodium and phosphorus were significantly lower in NODAT versus HC at P < 0.008 and P < 0.029. In multinomial logistic regression analysis, age, male gender, creatinine, and urea significantly predicted the outcome and the Receiver Operating Characteristic analysis revealed creatinine to be better marker for assessing kidney function. The Kaplan-Meier survival curve analysis showed decreased survival rates in NODAT than non-NODAT. Conclusion: Older age (above 40), hyponatremia, and hypophosphatemia could be significant risk factors for NODAT development.

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Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation

Cited by 32 publications

References 32 publications

Incidence and Risk Factors for the Development of New-Onset Diabetes after Kidney Transplantation

Incidence and Risk Factors for the Development of New-Onset Diabetes after Kidney Transplantation

Bariatric Surgery in Kidney Transplant Candidates and Recipients: Experience at an Asian Center

Assessment of Biochemical Parameters, Kidney Function, and Long-term Outcome in Renal Transplant Recipients

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