New onset diabetes after kidney transplantation in patients with autosomal dominant polycystic kidney disease: systematic review protocol

Abstract

IntroductionAutosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder with numerous cysts developing in bilateral kidneys. Meanwhile, ADPKD can also be regarded as a systemic disease because the cystic and non-cystic abnormalities could be identified in multiple organs in patients with ADPKD. Several lines of evidence suggest the risk of post-transplant diabetes mellitus or new-onset diabetes after transplantation (NODAT) is higher in patients with ADPKD compared with non-ADPKD renal recipients, but the available results are conflicting. We describe the protocol of a systematic review and meta-analysis for investigating the risk of NODAT in patients with ADPKD.Methods and analysisPubMed, EMBASE and The Cochrane Library will be searched. Cohort studies irrespective of language and publication status, comparing the incidence of NODAT in renal recipients with ADPKD and other kidney disease will be eligible. We will assess heterogeneity among studies. Along with 95% CIs, dichotomous data will be summarised as risk ratios; numbers needed to treat/harm and continuous data will be given as standard mean differences. Excluding outliers and testing small sample size studies if our results are robust, sensitivity analysis will be carried out.Ethics and disseminationEthical approval is not required because this study includes no confidential personal data or patient interventions. The review findings will be helpful in designing and implementing future studies and will be of interest to a wide range of readers, including healthcare professionals, researchers, health service managers and policymakers. The systematic review will be published in a peer-reviewed journal and disseminated electronically and in print.Trial registration numberThe study protocol has been registered in PROSPERO (http://www.crd.york.ac.uk/PROSPERO/) under registration number CRD42014009677.

Genetic factors in pathogenesis of diabetes mellitus after kidney transplantation

“…Common modifiable risk factors include obesity, sedentary lifestyle, other metabolic syndromes associated with obesity, some viral infections (eg, hepatitis C virus, cytomegalovirus), drugs used in posttransplantation therapy including corticosteroids, which are a mainstay of immunosuppression after transplantation of solid organs, and other immunosuppressive agents (eg, tacrolimus, cyclosporine and sirolimus) 3–9. The non-modifiable risk factors are advanced age, black race including African, Hispanic or South Asian descent, genetic background (eg, HLA B27 phenotype), previously diagnosed glucose intolerance and adult polycystic kidney disease 3,10–13. All of these risk factors contribute to beta-cell dysfunction in the pancreas prior to or after kidney transplantation.…”

“… 3 – 9 The non-modifiable risk factors are advanced age, black race including African, Hispanic or South Asian descent, genetic background (eg, HLA B27 phenotype), previously diagnosed glucose intolerance and adult polycystic kidney disease. 3 , 10 – 13 All of these risk factors contribute to beta-cell dysfunction in the pancreas prior to or after kidney transplantation. Previous studies suggest that genetic background plays an important role in the pathogenesis of PTDM.…”

“…The studies suggest that African, Hispanic and South Asian have higher incidence of PTDM. 3 , 10 – 13 …”