Predictors of new onset diabetes after renal transplantation

Abstract

The development of new onset diabetes after transplantation (NODAT) is associated with increased cardiovascular morbidity and mortality. This study aimed at identifying risk factors for the development of NODAT. We performed a retrospective review of 787 renal transplants performed between 1994 and 2004 at a single centre. NODAT was diagnosed in patients who had two random plasma glucose concentrations >11.1 mmol/L after the first month post-transplant or patients who required treatment for hyperglycaemia within the first month and continued treatment thereafter. The incidence of NODAT was 7.7%. The incidence of NODAT requiring either insulin or oral hypoglycaemic agents was 4.5%. Risk factors for the development of NODAT were older age (HR 1.04, 95% CI: 1.01-1.07, p < 0.01), heavier weight at time of transplantation (HR 1.04, 95% CI: 1.02-1.07, p < 0.01), higher mean pre-transplant random plasma glucose concentrations (HR 1.54, 95% CI: 1.14-2.08, p < 0.01), higher plasma glucose within the first seven d post-transplant (HR 1.27, 95% CI: 1.09-1.47, p < 0.01) and use of tacrolimus (HR 3.70, 95% CI: 1.61-8.46, p < 0.01). Ten yr actuarial patient survival was 67.1% in patients with NODAT compared with 81.9% for those without diabetes and 65.3% in patients known to have diabetes pre-transplant. There was no difference in graft survival. We have identified a high-risk group in which attempts should be made to reduce the incidence of NODAT by tailoring immunosuppression, lifestyle modification and selecting non-diabetogenic medications. Improvements in management of patients at higher risk of NODAT may help reduce the incidence of deaths with a functioning graft.

Posttransplant Increase of Body Mass Index is Associated with New-Onset Diabetes Mellitus after Kidney Transplantation

“…In the present study, pretransplant BMI itself was not associated with the incidence of NODAT; however, several studies have previously reported this relationship (Cosio et al 2005;Joss et al 2007;Bonato et al 2008). It has already been reported that weight gain between time of transplantation and 3 months to 1 year after transplantation was not a risk factor for NODAT (Gourishankar et al 2004;Kuypers et al 2008;Roland et al 2008).…”

“…A number of risk factors have been suggested to predict the development of NODAT: the recipient's older age (Cosio et al 2001;Kasiske et al 2003;Hoitsma and Hilbrands 2006;Shah et al 2006;Kuypers et al 2008), use of tacrolimus (Woodward et al 2003;Heisel et al 2004;Webster et al 2005;Hoitsma and Hilbrands 2006;Shah et al 2006;Ekberg et al 2007;Vincenti et al 2007), high pretransplant oral glucose tolerance test (OGTT) values (Bergrem et al 2010), and obesity (Kasiske et al 2003;Shah et al 2006;Joss et al 2007). Among these, obesity is likely to be an important therapeutic target because it can be safely modified by lifestyle-change intervention, including dietary modification and exercise.…”

Hyperparathyroidism and New Onset Diabetes After Renal Transplantation

“…19,22 NODAT is a common complication of renal transplantation 24 and increases the risk of graft failure [25][26][27] and cardiovascular mortality. 28,29 The major established risk factors are immunosuppressive agents (corticosteroids and calcineurin inhibitors).…”

“…17 Several other risk factors, such as pre-transplant obesity, genetic disposition and certain infections, have also been identified or suggested. 18,22,23,30 Incidence rates of NODAT between 2 and 53% have been reported in the literature. 31 In the present study the one-year cumulative incidence was 15% and the diagnosis was made within 180 days after transplantation in nearly 95% of all cases.…”

“…17 However, several other risk factors such as age, pre-transplant weight, certain infections and genetic predisposition have also been identified or suggested. [18][19][20][21][22][23] To the best of our knowledge, the role of hyperparathyroidism in developing NODAT has not been studied. This association could have important implications in the assessment of the individual patient risk of NODAT and in how to handle hyperparathyroidism in transplanted patients.…”