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Determinants of Poor Glycemic Control in Patients with Kidney Transplants: A Single-Center Retrospective Cohort Study
Daniel Chan Chun Kong1, Ayub Akbari1,2, Janine Malcolm1,3
1Faculty of Medicine, University of Ottawa, ON, Canada.
Background:
Kidney transplant immunosuppressive medications are known to impair glucose metabolism, causing worsened glycemic control in patients with pre-transplant diabetes mellitus (PrTDM) and new onset of diabetes after transplant (NODAT).
Objectives:
To determine the incidence, risk factors, and outcomes of both PrTDM and NODAT patients.
Design:
This is a single-center retrospective observational cohort study.
Setting:
The Ottawa Hospital, Ontario, Canada.
Participant:
A total of 132 adult (>18 years) kidney transplant patients from 2013 to 2015 were retrospectively followed 3 years post-transplant.
Measurements:
Patient characteristics, transplant information, pre- and post-transplant HbA1C and random glucose, follow-up appointments, complications, and readmissions.
Methods:
We looked at the prevalence of poor glycemic control (HbA1c >8.5%) in the PrTDM group before and after transplant and compared the prevalence, follow-up appointments, and rate of complications and readmission rates in both the PrTDM and NODAT groups. We determined the risk factors of developing poor glycemic control in PrTDM patients and NODAT. Student t-test was used to compare means, chi-squared test was used to compare percentages, and univariate analysis to determine risk factors was performed by logistical regression.
Results:
A total of 42 patients (31.8%) had PrTDM and 12 patients (13.3%) developed NODAT. Poor glycemic control (HbA1c >8.5%) was more prevalent in the PrTDM (76.4%) patients compared to those with NODAT (16.7%; P < .01). PrTDM patients were more likely to receive follow-up with an endocrinologist (P < .01) and diabetes nurse (P < .01) compared to those with NODAT. There were no differences in the complication and readmission rates for PrTDM and NODAT patients. Receiving a transplant from a deceased donor was associated with having poor glycemic control, odds ratio (OR) = 3.34, confidence interval (CI = 1.08, 10.4), P = .04. Both patient age, OR = 1.07, CI (1.02, 1.3), P < .01, and peritoneal dialysis prior to transplant, OR = 4.57, CI (1.28, 16.3), P = .02, were associated with NODAT.
Limitations:
Our study was limited by our small sample size. We also could not account for any diabetes screening performed outside of our center or follow-up appointments with family physicians or community endocrinologists.
Conclusion:
Poor glycemic control is common in the kidney transplant population. Glycemic targets for patients with PrTDM are not being met in our center and our study highlights the gap in the literature focusing on the prevalence and outcomes of poor glycemic control in these patients. Closer follow-up and attention may be needed for those who are at risk for worse glycemic control, which include older patients, those who received a deceased donor kidney, and/or prior peritoneal dialysis.
Insights
Poor glycemic control is prevalent in kidney transplant patients. Pre-transplant diabetes mellitus (PrTDM) patients show higher rates of poor glycemic control than new-onset diabetes after transplant (NODAT) patients, indicating a need for closer monitoring.
Area of Science:
- Nephrology
- Endocrinology
- Immunology
Background:
- Kidney transplant immunosuppressants can negatively impact glucose metabolism.
- This can worsen glycemic control in patients with pre-transplant diabetes mellitus (PrTDM) and lead to new-onset diabetes after transplant (NODAT).
Purpose of the Study:
- To investigate the incidence, risk factors, and outcomes of PrTDM and NODAT in kidney transplant recipients.
- To assess the prevalence of poor glycemic control (HbA1c >8.5%) in these patient groups.
Main Methods:
- A retrospective observational cohort study at a single center.
- 132 adult kidney transplant patients were followed for 3 years post-transplant.
- Data included patient characteristics, transplant details, glycemic levels, and complications.
Main Results:
- 31.8% had PrTDM and 13.3% developed NODAT.
- Poor glycemic control was significantly more common in PrTDM (76.4%) than NODAT (16.7%) patients.
- Older age, deceased donor transplants, and prior peritoneal dialysis were risk factors for poor glycemic control or NODAT.
Conclusions:
- Poor glycemic control is a significant issue in kidney transplant recipients.
- Current glycemic targets are not consistently met for PrTDM patients.
- Increased attention and follow-up are needed for high-risk individuals, including older patients, those with deceased donor transplants, and those with a history of peritoneal dialysis.
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