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New-onset diabetes after transplantation: drug-related risk factors
L Santos1, E Rodrigo, C Piñera
1Nephrology Service, Hospital Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain. li-santos@hotmail.com
Introduction:
New-onset diabetes after transplantation (NODAT), an important complication of renal transplantation leads to reduced graft function and increased patient morbidity and mortality. Because of its high incidence and immense impact on clinical outcomes, prevention of NODAT is highly desirable. Several modifiable and nonmodifiable risk factors for NODAT have been described. The aim of this study was to analyze the influence of various drugs on the development of NODAT during the first year.
Methods:
A retrospective analysis was performed on 303 adult kidney transplant recipients free of previously known diabetes. NODAT was defined as a fasting plasma glucose level ≥ 126 mg/dL confirmed by repeat testing on a different day. We excluded patients with transiently elevated fasting plasma glucose during the first 3 months.
Results:
NODAT was diagnosed in 37 recipients (12.2%). Univariate analysis identified several variables related to NODAT: recipient age (P < .001), body mass index (P < .001), donor age (P = .005), family history of diabetes (P < .001), statin use (P = .005), diuretic use (P = .040) and tacrolimus therapy (P = .029). After multivariate analysis, recipient age (relative risk [RR] = 1.060, 95% confidence interval [CI] 1.019- 1.102, P = .004), family history of diabetes (RR = 3.562, 95% CI 1.574-8.058, P = .002), smoking habit (RR 2.514, 95% CI 1.118-5.655, P = .026) and diuretic use (RR = 2.496, 95% CI 1.087-5.733, P = .031) were independently associated with NODAT development.
Conclusions:
In our population of kidney transplant recipients, the main nonmodifiable risk factors for NODAT were recipient age and a family history of diabetes. Diuretic use was a modifiable risk factor associated with the development of NODAT. To reduce NODAT incidence, it is necessary to consider not only immunosuppressive therapy, but also concomitant drugs such as diuretics.
Insights
New-onset diabetes after transplantation (NODAT) is linked to recipient age and family history. Diuretic use is a modifiable risk factor for NODAT in kidney transplant patients, highlighting the need to consider all medications.
Area of Science:
- Nephrology
- Endocrinology
- Clinical Pharmacology
Background:
- New-onset diabetes after transplantation (NODAT) is a significant complication following renal transplantation, negatively impacting graft function, patient morbidity, and mortality.
- Preventing NODAT is crucial due to its high incidence and substantial effect on clinical outcomes.
- Both modifiable and nonmodifiable risk factors for NODAT have been identified.
Purpose of the Study:
- To investigate the influence of various medications on the development of NODAT within the first year post-kidney transplantation.
Main Methods:
- A retrospective analysis was conducted on 303 adult kidney transplant recipients without pre-existing diabetes.
- NODAT was defined by fasting plasma glucose ≥ 126 mg/dL, confirmed on a separate day.
- Patients with transiently elevated glucose in the first three months were excluded.
Main Results:
- NODAT was diagnosed in 12.2% (37) of recipients.
- Multivariate analysis revealed independent associations between NODAT and recipient age (RR=1.060), family history of diabetes (RR=3.562), smoking (RR=2.514), and diuretic use (RR=2.496).
Conclusions:
- Recipient age and family history of diabetes are key nonmodifiable risk factors for NODAT in kidney transplant recipients.
- Diuretic use emerged as a significant modifiable risk factor associated with NODAT development.
- Reducing NODAT incidence requires consideration of concomitant medications, including diuretics, alongside immunosuppressive therapy.
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