Reduction in New Onset Diabetes After Transplant (NODAT) with Erythropoietin-Stimulating Agents, a Case Control Study

Abstract

New-onset diabetes mellitus after transplantation (NODAT) adversely affects graft and patient survival. Studies have shown that erythropoietin-stimulating agents (ESA) protect mice against the development of diabetes through direct effects on pancreatic ß cells. However, the effect of ESA on the risk of diabetes in humans has not been well studied. We performed a case-control analysis of patients with NODAT who received a first live or deceased donor renal allograft, comparing those with exposure to an ESA versus those without such exposure. Patients with a prior history of diabetes mellitus or more than 1 renal transplant were excluded. Multivariate logistic regression analysis was performed to determine factors independently associated with NODAT including age, body mass index, acute rejection, donor source and random blood sugar (RBS) at discharge. Results showed 13.4% had NODAT whereas 86.6% did not. Twenty-one percent with NODAT were exposed to an ESA compared to 79% who were not. Exposure to an ESA for up to 6 months duration at any time post-transplant reduced the risk of developing NODAT (OR=0.063, CI=0.008 to 0.493, p=0.012). Increasing age (OR=1.422, CI=1.077 to 1.932, p<0.0001) and higher RBS at discharge (OR 1.39, CI=1.167 to 1.658, p<0.0001) were associated with an increased risk of NODAT. The risk for developing NODAT was significantly reduced in patients who were exposed to an ESA compared to those who were not exposed. There may be a role for ESAs in preventing NODAT particularly if given for up to 6 months duration post-transplant.