New-onset diabetes after kidney transplantation: Incidence and associated factors

Abstract

AIMTo determine the incidence and associated factors of new-onset diabetes after transplantation (NODAT) in a Portuguese central hospital.METHODSThis single-center retrospective study involved consecutive adult nondiabetic transplant recipients, who had undergone kidney transplantation between January 2012 and March 2016. NODAT was diagnosed according to the criteria of the American Diabetes Association. Data were collected from an institutional database of the Nephrology and Kidney Transplantation Department (Santa Maria Hospital, Lisbon, Portugal) and augmented with data of laboratorial parameters collected from the corresponding patient electronic medical records. Exclusion criteria were preexisting diabetes mellitus, missing information and follow-up period of less than 12 mo. Data on demographic and clinical characteristics as well as anthropometric and laboratorial parameters were also collected. Patients were divided into two groups: With and without NODAT - for statistical comparison.RESULTSA total of 156 patients received kidney transplant during the study period, 125 of who were included in our analysis. NODAT was identified in 27.2% of the patients (n = 34; 53% female; mean age: 49.5 ± 10.8 years; median follow-up: 36.4 ± 2.5 mo). The incidence in the first year was 24.8%. The median time to diagnosis was 3.68 ± 5.7 mo after transplantation, and 76.5% of the patients developed NODAT in the first 3 mo. In the group that did not develop NODAT (n = 91), 47% were female, with mean age of 46.4 ± 13.5 years and median follow-up of 35.5 ± 1.6 mo. In the NODAT group, the pretransplant fasting plasma glucose (FPG) levels were significantly higher [101 (96.1-105.7) mg/dL vs 92 (91.4-95.8) mg/dL, P = 0.007] and pretransplant impaired fasting glucose (IFG) was significantly more frequent (51.5% vs 27.7%, P = 0.01). Higher pretransplant FPG levels and pretransplant IFG were found to be predictive risk factors for NODAT development [odds ratio (OR): 1.059, P = 0.003; OR: 2.772, P = 0.017, respectively].CONCLUSIONNODAT incidence was high in our renal transplant recipients, particularly in the first 3 mo posttransplant, and higher pretransplant FPG level and IFG were risk factors.

Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

“…Polymorphisms in the IL7R (rs1494558) and MBL2 (rs2232365) genes were associated with a higher risk of NODAT among pooled Malaysian renal transplanted populations. Despite similar diagnostic criteria, high variability in the incidence of NODAT within 1 year posttransplantation has been reported in different populations [19][20][21]. The incidence of NODAT at one-year post-transplantation in our study was slightly higher [14] in their studies in single centres in Malaysia.…”

“…Despite similar diagnostic criteria, high variability in the incidence of NODAT within 1 year post-transplantation has been reported in different populations [ 19 – 21 ]. The incidence of NODAT at one-year post-transplantation in our study was slightly higher than the earlier reports by Foo et al (13.3%) [ 15 ] and Lai et al (5.5%) [ 14 ] in their studies in single centres in Malaysia.…”

Risk Factors Related to New-Onset Diabetes after Renal Transplantation in Patients of a High Complexity University Hospital in Colombia, 20 Years of Experience

“…Regarding pretransplant glycemic values, Cosio et al have described that patients with values <90 mg/dl have a lower risk for NODAT (OR 0.46, p = 0.01), contrary to individuals with values between 101 and 110 mg/dl (OR 1.5, p ≤ 0.0001) and between 110 and 125 mg/dl (OR 7.6, p ≤ 0.0001) [ 24 ]. These values evidence a pretransplant insulin resistance, similar to findings reported by Gomes et al recently [ 25 ].…”

“…ese values evidence a pretransplant insulin resistance, similar to findings reported by Gomes et al recently [25]. International Journal of Endocrinology With respect to pretransplant hypertriglyceridemia, its role as a marker for insulin resistance has been clearly studied, and in multivariable analysis of some retrospective cohorts, it has been associated with NODAT [26].…”

New-Onset Diabetes after Kidney Transplantation

“…At least initially and often throughout their lifetime, these individuals do not need insulin treatment to survive. NODAT usually develops within three months after transplantation and has been reported to occur in 4% to 27% of KT recipients [ 13 , 14 , 15 , 16 ]. This incidence-related variability may be accounted for by age, ethnicity, lifestyle, length of follow-up, and presence of modifiable and non-modifiable risk factors.…”