Autosomal Dominant Polycystic Kidney Disease Reduces the Risk of Diabetes Mellitus

Abstract

Patients with autosomal dominant polycystic kidney disease (ADPKD) are at greater risk of new-onset diabetes after transplantation as compared with other renal graft recipients. We mailed questionnaires to 459 ADPKD patients retrieved from the Polish Registry of ADPKD. We analyzed data from 291 respondents and 271 siblings with a known status of ADPKD and diabetes. The prevalence of transplant-unrelated diabetes was significantly higher in siblings without ADPKD (8.2%) than in respondents (1.7%; p = 0.0028) and their ADPKD siblings (2.0%; p = 0.023). Univariate logistic regression demonstrated that the prevalence odds ratio (POR) for transplant-unrelated diabetes in the pooled ADPKD group vs. siblings without ADPKD was 0.21 (95% CI: 0.08-0.54, p = 0.0013). Multivariate regression accounting for age and gender disclosed an even smaller POR for diabetes (0.18) in ADPKD patients (95% CI: 0.07-0.47, p = 0.00049). Age was a significant risk factor for diabetes (POR 1.05, 95% CI: 1.01-1.09 per year of life; p = 0.025) and gender was without effect. The prevalence of diabetes in females and males with vs. without ADPKD was similar (1.6% vs. 8.3%, p = 0.0091 for females; 2.2% vs. 8.0%, p = 0.069 for males). Age and gender were not inter-related. In the group of siblings without ADPKD diabetes was associated with higher age (62.2 +/- 15.6 vs. 47.0 +/- 16.3 years, p = 0.0053). Our findings demonstrate lower prevalence of transplant-unrelated diabetes among ADPKD patients. We hypothesize that metabolic disturbances in polycystic kidneys suppress the synthesis of endogenous glucose and reduce renal breakdown of insulin.