Abstract
New-onset diabetes mellitus (NODM)-a common complication of kidney transplantation-is associated with increases in graft loss, morbidity and mortality. This is a purely observational study of 527 patients taking a calcineurin inhibitor (CNI), based on data collected at a single routine visit 6-24 months after kidney transplantation. Diabetes was defined according to ADA/WHO guidelines. The mean age of the patients was 47.2 years and 61.1% were men; 49.5% were receiving cyclosporine microemulsion (CsA-ME) and 50.5% tacrolimus (Tac). NODM developed in 7.0% after a median interval of 1.6 months. In CsA-ME-treated patients, the unadjusted cumulative risks of NODM were 5.5% and 8.4% at 1- and 2-year post-transplantation, while in Tac-treated patients, the risks were respectively 17.4% and 21%. Four independent risk factors (RFs) were identified by multivariate analysis: maximum lifetime body mass index>25 [odds ratio (OR)=5.1], pre-transplantation impaired fasting glucose (OR=4.7), hepatitis C status (OR=4.7) and Tac vs CsA-ME treatment (OR=3.0). NODM is associated with certain RFs present prior to kidney transplantation, and with treatment with Tac as opposed to CsA-ME.
Highlights
New-onset diabetes mellitus (NODM) is a common complication of kidney transplantation
Post-transplant NODM has been shown to be associated with an increased incidence of infectious [1] and cardiovascular complications [2,3] as well as, most pertinently, impaired long-term graft function and reduced survival [4,5]; one large-scale study reported that the relative risk of graft loss 12 years after kidney transplantation was 3.72 times higher in patients who had developed NODM than in those with normal glucose metabolism [6]
The data obtained by meta-analytic approaches ought to be treated with caution, e.g. a European transplant specialist may not be entitled to be encouraged by a rate of NODM below that of the 13.4% reported in the broadest meta-analysis published to date [14] as this is largely based on North American data
Summary
New-onset diabetes mellitus (NODM) is a common complication of kidney transplantation. Post-transplant NODM has been shown to be associated with an increased incidence of infectious [1] and cardiovascular complications [2,3] as well as, most pertinently, impaired long-term graft function and reduced survival [4,5]; one large-scale study reported that the relative risk of graft loss 12 years after kidney transplantation was 3.72 times higher in patients who had developed NODM than in those with normal glucose metabolism [6]. Diabetes and impaired glucose metabolism are by no means permanent in all cases, often resolving spontaneously even without treatment There are both temporal and geographical variations: has the incidence of NODM been greatly reduced since the early days of transplantation (largely due to the availability of effective but less diabetogenic immunosuppressive modalities) but it seems to vary from one part of the world to another. NODM is associated with certain RFs present prior to kidney transplantation, and with treatment with Tac as opposed to CsA-ME
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