Modifiable Variables Are Major Risk Factors for Posttransplant Diabetes Mellitus in a Time-Dependent Manner in Kidney Transplant: An Observational Cohort Study
| Autor: | João Roberto de Sá, Erika B Rangel, Débora Dias de Lucena, Jose O. Medina-Pestana |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Multivariate analysis Article Subject Endocrinology Diabetes and Metabolism 030232 urology & nephrology 030204 cardiovascular system & hematology Overweight Gastroenterology Tacrolimus Diseases of the endocrine glands. Clinical endocrinology Cohort Studies 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Endocrinology Insulin resistance Postoperative Complications Prednisone Risk Factors Internal medicine medicine Diabetes Mellitus Humans Univariate analysis Triglyceride business.industry Age Factors Middle Aged Mycophenolic Acid medicine.disease RC648-665 Kidney Transplantation chemistry Clinical Study Female medicine.symptom business Immunosuppressive Agents Cohort study medicine.drug |
| Zdroj: | Journal of Diabetes Research, Vol 2020 (2020) Journal of Diabetes Research |
| ISSN: | 2314-6745 |
| DOI: | 10.1155/2020/1938703 |
| Popis: | Modifiable and nonmodifiable risk factors for developing posttransplant diabetes mellitus (PTDM) have already been established in kidney transplant setting and impact adversely both patient and allograft survival. We analysed 450 recipients of living and deceased donor kidney transplants using current immunosuppressive regimen in the modern era and verified PTDM prevalence and risk factors over three-year posttransplant. Tacrolimus (85%), prednisone (100%), and mycophenolate (53%) were the main immunosuppressive regimen. Sixty-one recipients (13.5%) developed PTDM and remained in this condition throughout the study, whereas 74 (16.5%) recipients developed altered fasting glucose over time. Univariate analyses demonstrated that recipient age (46.2±1.3vs.40.7±0.6years old, OR 1.04;P=0.001) and pretransplant hyperglycaemia andBMI≥25 kg/m2(32.8%vs. 21.6%, OR 0.54;P=0.032and 57.4%vs. 27.7%, OR 3.5;P<0.0001, respectively) were the pretransplant variables associated with PTDM. Posttransplant transient hyperglycaemia (86.8%. 18.5%, OR 0.03;P=0.0001), acute rejection (P=0.021), calcium channel blockers (P=0.014), TG/HDL (triglyceride/high-density lipoprotein cholesterol)ratio≥3.5at 1 year (P=0.01) and at 3 years (P=0.0001), and tacrolimus trough levels at months 1, 3, and 6 were equally predictors of PTDM. In multivariate analyses, pretransplant hyperglycaemia (P=0.035),pretransplant BMI≥25 kg/m2(P=0.0001), posttransplant transient hyperglycaemia (P=0.0001), andTG/HDL ratio≥3.5at 3-year posttransplant (P=0.003) were associated with PTDM diagnosis and maintenance over time. Early identification of risk factors associated with increased insulin resistance and decreased insulin secretion, such as pretransplant hyperglycaemia and overweight, posttransplant transient hyperglycaemia, tacrolimus trough levels, and TG/HDL ratio may be useful for risk stratification of patients to determine appropriate strategies to reduce PTDM. |
| Databáze: | OpenAIRE |
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