Abstract
BackgroundWe investigated whether serum uric acid (SUA) levels before kidney transplantation predict new-onset diabetes after kidney transplantation (NODAT) and compared SUA levels with known risk factors for NODAT by prospective cohort study.MethodsA total of 151 adult kidney recipients without diabetes (84 men, 67 women) who underwent living-donor kidney transplantation between 2001 and 2011 were followed in this study. The Cox proportional hazards model was used to analyse the risk of NODAT.ResultsDuring the follow-up period (median 3.3 years, range 0–10 years), 32 (21.2%) adult kidney recipients without diabetes developed NODAT, and an incidence rate was 5.6 per 100 person-years and a 10-year cumulative incidence of 26.9%. When subjects were stratified by SUA levels into tertiles, the patients in the highest tertile (> 8.6 mg/dl for men, > 7.7 mg/dl for women) had a significantly higher risk of NODAT than the patients in the lower 2 tertiles (log-rank test, P = 0.03). In the univariate analysis, increased level of SUA was associated with NODAT (hazard ratio 1.27 [95% CI 1.04–1.55], P = 0.01). In the multivariate analysis, increased level of SUA was significantly associated with NODAT after correction by any factors, e.g. (age, sex, family history of diabetes, BMI, HbA1c, serum creatinine, tacrolimus, HCV) factors directly affecting the SUA value (1.26 [1.02–1.56], P = 0.03), risk factors for T2DM onset (1.34 [1.10–1.64], P = 0.03), and factors previously reported risk factors for NODAT (1.36 [1.11–1.66], P = 0.003).ConclusionSUA independently predicts NODAT in living-donor kidney transplantation patients.
Highlights
We investigated whether serum uric acid (SUA) levels before kidney transplantation predict newonset diabetes after kidney transplantation (NODAT) and compared SUA levels with known risk factors for NODAT by prospective cohort study
NODAT was defined as fasting plasma glucose ≥ 126 mg/dL, random plasma glucose ≥ 200 mg/dL confirmed by repeated testing on a different day, and/or starting oral hypoglycaemic agents or insulin for diabetes treatment after the first 2 weeks post-transplant [11], as defined by the American Diabetes Association and the Japanese diabetes criteria described in 1999 by the Japan Diabetes Society guidelines
There were no differences between the groups in sex, age, family history of diabetes, body mass index (BMI), haemoglobin A1c (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), I-I, hepatitis C virus (HCV) infection status, or the frequency of medication use, including diuretics, lipid-lowering agents, antihypertensive agents, antiplatelet agents, and immunosuppressive agents (Table 1)
Summary
We investigated whether serum uric acid (SUA) levels before kidney transplantation predict newonset diabetes after kidney transplantation (NODAT) and compared SUA levels with known risk factors for NODAT by prospective cohort study. The reported incidence of NODAT in kidney transplantation varies between 2 and 53% [1, 3, 4]. The serum uric acid (SUA) level has been suggested to be associated with a risk of T2DM onset [8]. Pre-transplant metabolic syndrome is an independent predictor of NODAT [10]. The mechanism of NODAT is not yet known, and whether SUA and/or risk factors for the onset of T2DM are applicable to NODAT has not been well established. We aim to provide the first evidence that the pre-transplant SUA level is a predictor of NODAT among kidney allograft recipients
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