scholarly journals Impact of Diabetes Mellitus on Renal transplant outcome

2021 ◽  
pp. 057-064
Author(s):  
Abbasi Muhammad Tanzeel ◽  
Arif Mariam ◽  
Saleem Nayyar
Keyword(s):  
Diabetes Mellitus ◽  
Renal Transplant ◽  
Glycemic Control ◽  
Diabetic Patients ◽  
Renal Transplant Recipients ◽  
Post Transplant ◽  
Metabolic Complication ◽  
Wide Range ◽  
The Impact ◽  
Hba1c Levels

Diabetes Mellitus (DM) is a potent risk factor for post-transplant cardiovascular complications and infections. Management of diabetes and its complications in renal transplant recipients is a challenging task. This is a frequently encountered predicament in transplant setups. An erratic glycemic control during dialysis is a predictor of poor graft and patient outcomes after kidney transplantation. Literature review reveals majority studies explaining post-transplant diabetes and its role in graft and patient survival. However, a wide range of opinion exists about the impact of pre-transplant DM on transplant outcomes. Measurement of HbA1c levels is a significant tool for assessment of glycemic control. A target HbA1c level of <7% is recommended for diabetic patients irrespective of presence or absence of Chronic Kidney Disease (CKD). However, diabetic patients with CKD are at risk of hypoglycemia owing to decreased insulin metabolism so it is safe to keep HbA1c levels between 7-8% in this population. Immunosuppressive medications have a strong contributory role in deterioration of glycemic control. So, it is imperative to achieve strict pre-transplant diabetes control in order to avoid post-transplant complications. Post-transplant diabetes mellitus (PTDM) has been a subject of a large number of trials and is not only considered a serious metabolic complication but also a predisposing factor of diabetic nephropathy in transplanted kidney.

scholarly journals RENAL TRANSPLANT RECIPIENTS

2015 ◽  
Vol 22 (05) ◽  
pp. 590-595
Author(s):  
Ruhina Akbar ◽  
Naeem Kauser ◽  
Naveed Hussain
Keyword(s):  
Renal Transplant ◽  
Glycemic Control ◽  
Lipid Profile ◽  
Renal Transplant Recipients ◽  
Lipid Modification ◽  
Transplant Recipients ◽  
Kidney Dialysis ◽  
Post Transplant ◽  
The Mean ◽  
Hba1c Levels

Introduction: Good glycemic control and lipid modification are potentiallyimportant intervention for improving outcome after kidney transplantation. Objective: Todetermine the frequency of dyslipidemia and its types in renal transplant recipients (RTRs),and to observe impact of hyperglycemia on their lipid profile. Design: Case control study.Period: June 2011 to May 2012. Setting: Kidney Dialysis Department of Jinnah HospitalLahore, Urology Department of Mayo Hospital Lahore and Pathology Department AllamaIqbal Medical College Lahore. Patients and Methods: A total of 40 RTR were included in thestudy. An equal number of sex and age matched healthy subjects were considered as controlgroup. The patients were on regular post transplant follow up in Kidney Dialysis Department ofJinnah Hospital Lahore and Urology Department of Mayo Hospital Lahore and had no clinicalor laboratory evidence of graft rejection, post-transplant diabetes mellitus, hypertension or intercurrent infection. Total cholesterol (TC), triglyceride (TG), High density Lipoprotein-Cholesterol(HDL-C), and Glycohemoglobin A1c (HbA1c) were estimated in all subjects. These subjectswere divided into Diabetic and non-diabetic groups, according to level of HbA1c. Results:The mean age of the RTR was 34.5± 9.02 years and the mean duration of transplant was36.70 ± 38.07 months. RTRs showed significantly high mean levels of TG (p< 0.002), TC (p<0.00), LDL-C (p< 0.01), and HDL-C (p< 0.05) as compared to the control subjects. ElevatedTC, TG, LDL-C and low HDL was observed in 32.5%, 72.5%, 52.5%, and 60% of total RTR,respectively. The mean levels of TC, TG and HDL-C were increased in Diabetic transplant groupas compared to non-diabetic RTR. Percentage of elevated TC, TG, LDL-C and decreased HDLin diabetic group of RTR versus non diabetic RTR was 43.7% Vs 25% , 81.2% Vs 66.6%, , 62.5%Vs 44.4%, and 50% Vs 66.6% respectively. There was a positive relationship between HbA1cand lipid profile (TC, TG, and LDL – C) in both Diabetic and Non Diabetic Group. A statisticallysignificant correlation of the mean HbA1c levels with TG level was observed in Diabetic RTR.Conclusion: Dyslipidemia in our RTRs was observed as elevated levels of TC, TG and LDL-C. Indiabetic RTR, a statistically significant positive correlation of the HbA1c levels with TG level wasobserved. More rigorous glycemic control and lipid modification will reduce the development ofmicrovascular complications.

scholarly journals Post-Transplant Diabetes Mellitus and Prediabetes in Renal Transplant Recipients: An Update

Nephron ◽  
2021 ◽  
pp. 1-13
Author(s):  
Ana Elena Rodríguez-Rodríguez ◽  
Esteban Porrini ◽  
Mads Hornum ◽  
Javier Donate-Correa ◽  
Raúl Morales-Febles ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Renal Transplant ◽  
Cell Function ◽  
Cell Damage ◽  
Current Evidence ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Β Cell Function

Post-transplant diabetes mellitus (PTDM) is a frequent and relevant complication after renal transplantation: it affects 20–30% of renal transplant recipients and increases the risk for cardiovascular and infectious events. Thus, understanding pathogenesis of PTDM would help limiting its consequences. In this review, we analyse novel aspects of PTDM, based on studies of the last decade, such as the clinical evolution of PTDM, early and late, the reversibility rate, diagnostic criteria, risk factors, including pre-transplant metabolic syndrome and insulin resistance (IR) and the interaction between these factors and immunosuppressive medications. Also, we discuss novel pathogenic factors, in particular the role of β-cell function in an environment of IR and common pathways between pre-existing cell damage and tacrolimus-induced toxicity. The relevant role of prediabetes in the pathogenesis of PTDM and cardiovascular disease is also addressed. Finally, current evidence on PTDM treatment is discussed.

scholarly journals Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Donal J Sexton ◽  
Susan L Murray ◽  
Chaudhry E Adeel ◽  
Patrick O’Kelly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplant ◽  
Graft Failure ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Post Transplant ◽  
All Cause Mortality ◽  
Transplant Function ◽  
The Republic ◽  
The Impact

Abstract Background Non-traditional cardiovascular risk factors, including calcium and phosphate derangement, may play a role in mortality in renal transplant. The data regarding this effect are conflicting. Our aim was to assess the impact of calcium and phosphate derangements in the first 90 days post-transplant on allograft and recipient outcomes. Methods We performed a retrospective cohort review of all-adult, first renal transplants in the Republic of Ireland between 1999 and 2015. We divided patients into tertiles based on serum phosphate and calcium levels post-transplant. We assessed their effect on death-censored graft survival and all-cause mortality. We used Stata for statistical analysis and did survival analysis and spline curves to assess the association. Results We included 1525 renal transplant recipients. Of the total, 86.3% had hypophosphataemia and 36.1% hypercalcaemia. Patients in the lowest phosphate tertile were younger, more likely female, had lower weight, more time on dialysis, received a kidney from a younger donor, had less delayed graft function and better transplant function compared with other tertiles. Patients in the highest calcium tertile were younger, more likely male, had higher body mass index, more time on dialysis and better transplant function. Adjusting for differences between groups, we were unable to show any difference in death-censored graft failure [phosphate = 1.14, 95% confidence interval (CI) 0.92–1.41; calcium = 0.98, 95% CI 0.80–1.20] or all-cause mortality (phosphate = 1.10, 95% CI 0.91–1.32; calcium = 0.96, 95% CI 0.81–1.13) based on tertiles of calcium or phosphate in the initial 90 days. Conclusions Hypophosphataemia and hypercalcaemia are common occurrences post-kidney transplant. We have identified different risk factors for these metabolic derangements. The calcium and phosphate levels exhibit no independent association with death-censored graft failure and mortality.

scholarly journals High Plasma Branched-Chain Amino Acids Are Associated with Higher Risk of Post-Transplant Diabetes Mellitus in Renal Transplant Recipients

2020 ◽  
Vol 9 (2) ◽  
pp. 511 ◽  
Author(s):  
Maryse C. J. Osté ◽  
Jose L. Flores-Guerrero ◽  
Eke G. Gruppen ◽  
Lyanne M. Kieneker ◽  
Margery A. Connelly ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Amino Acids ◽  
Renal Transplant ◽  
Branched Chain Amino Acids ◽  
Resonance Spectroscopy ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Branched Chain

Post-transplant diabetes mellitus (PTDM) is a serious complication in renal transplant recipients. Branched-chain amino acids (BCAAs) are involved in the pathogenesis of insulin resistance. We determined the association of plasma BCAAs with PTDM and included adult renal transplant recipients (≥18 y) with a functioning graft for ≥1 year in this cross-sectional cohort study with prospective follow-up. Plasma BCAAs were measured in 518 subjects using nuclear magnetic resonance spectroscopy. We excluded subjects with a history of diabetes, leaving 368 non-diabetic renal transplant recipients eligible for analyses. Cox proportional hazards analyses were used to assess the association of BCAAs with the development of PTDM. Mean age was 51.1 ± 13.6 y (53.6% men) and plasma BCAA was 377.6 ± 82.5 µM. During median follow-up of 5.3 (IQR, 4.2–6.0) y, 38 (9.8%) patients developed PTDM. BCAAs were associated with a higher risk of developing PTDM (HR: 1.43, 95% CI 1.08–1.89) per SD change (p = 0.01), independent of age and sex. Adjustment for other potential confounders did not significantly change this association, although adjustment for HbA1c eliminated it. The association was mediated to a considerable extent (53%) by HbA1c. The association was also modified by HbA1c; BCAAs were only associated with renal transplant recipients without prediabetes (HbA1c < 5.7%). In conclusion, high concentrations of plasma BCAAs are associated with developing PTDM in renal transplant recipients. Alterations in BCAAs may represent an early predictive biomarker for PTDM.

Vaccination titres pre- and post-transplant in paediatric renal transplant recipients and the impact of immunosuppressive therapy

2018 ◽  
Vol 33 (5) ◽  
pp. 897-910 ◽  
Author(s):  
Britta Höcker ◽  
Martin Aguilar ◽  
Paul Schnitzler ◽  
Lars Pape ◽  
Martin Bald ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Immunosuppressive Therapy ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
The Impact

scholarly journals Association between glycemic control and risk of venous thromboembolism in diabetic patients: a nested case–control study

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah H. R. Charlier ◽  
Christian Meier ◽  
Susan S. Jick ◽  
Christoph R. Meier ◽  
Claudia Becker
Keyword(s):  
Venous Thromboembolism ◽  
Glycemic Control ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Diabetic Patients ◽  
Control Analysis ◽  
Using Data ◽  
Nested Case Control ◽  
The Impact ◽  
Hba1c Levels

Abstract Background Previous studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. The impact of glycemic control on the risk of VTE is unclear. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM. Methods We conducted a nested case–control analysis (1:4 matching) within a cohort of patients with incident T2DM between 1995 and 2019 using data from the CPRD GOLD. We excluded patients with known risk factors for VTE prior to onset of DM. Cases were T2DM patients with an unprovoked treated VTE. The exposure of interest was glycemic control measured as HbA1c levels. We conducted conditional logistic regression analyses adjusted for several confounders. Results We identified 2′653 VTE cases and 10′612 controls (53.1% females). We found no association between the HbA1c level and the risk of VTE in our analyses. However, when the most recent HbA1c value was recorded within 90 days before the index date, women with HbA1c levels > 7.0% had a 36–55% increased relative risk of VTE when compared to women with HbA1c > 6.5–7.0%. Conclusions Our study raises the possibility that female T2DM patients with HbA1c levels > 7% may have a slightly higher risk for unprovoked VTE compared to women with HbA1c levels > 6.5–7.0%. This increase may not be causal and may reflect differences in life style or other characteristics. We observed no effect of glycemic control on the risk of VTE in men.

scholarly journals A prospective observational study on the traditional and novel risk factors associated with post-transplant diabetes mellitus in renal transplant recipients

Biomedicine ◽  
2021 ◽  
Vol 41 (2) ◽  
pp. 482-488
Author(s):  
Krithika Muralidhara ◽  
Subramanian Kannan ◽  
Ishthiaque Ahamed ◽  
Krishna Kishore ◽  
Llyod Vincent ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Transplant ◽  
Trace Element ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Factors Associated ◽  
Novel Risk Factors ◽  
Traditional Risk Factors

Introduction and Aim: Post Transplant Diabetes Mellitus (PTDM) constitutes a major co-morbidity that has significant impact on the patient and renal allograft outcome. Various traditional risk factors like dialysis vintage, immunosuppressive medication, viral infections have known to be associated with PTDM. Novel risk factors and its causative role in PTDM remains unexplored. The study looked at the incidence of PTDM at 6 months post renal transplantation and correlation of PTDM with known traditional and novel risk factors like pre-transplant C-reactive protein (CRP) level and Trace element deficiency.   Material and Methods: 30 consecutive renal transplant recipients more than 18 years of age were inducted into the study. Demographic data, known pre-transplant and post-transplant risk factors associated with development of PTDM were collected. Pre-transplant CRP and serum Trace element (Aluminum, Copper, Selenium and Zinc) levels were estimated. PTDM was diagnosed by home based glucometer monitoring and confirmed by Oral glucose tolerance test (OGTT).   Results: The incidence of PTDM was 36.6% at six months post renal transplant. Among the pre-transplant risk factors, higher age and positive family history of diabetes mellitus had a strong association with the occurrence of PTDM. Pre-transplant Zinc deficiency emerged as a significant novel risk factor for the development of PTDM.   Conclusion: Apart from known traditional risk factors, novel risk factors are associated with development of PTDM.

scholarly journals Association between glycemic control and risk of venous thromboembolism in diabetic patients: A nested case-control study

2021 ◽  
Author(s):  
Sarah H R Charlier ◽  
Christian Meier ◽  
Susan S Jick ◽  
Christoph R Meier ◽  
Claudia Becker
Keyword(s):  
Venous Thromboembolism ◽  
Glycemic Control ◽  
Hba1c Level ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Diabetic Patients ◽  
Control Analysis ◽  
Nested Case Control ◽  
The Impact ◽  
Hba1c Levels

Abstract Background:Previous studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. The impact of glycemic control on the risk of VTE is unclear. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM.Methods:We conducted a nested case-control analysis (1:4 matching) within a cohort of patients with incident T2DM between 1995–2019 using data from the CPRD GOLD. We excluded patients with known risk factors for VTE prior to onset of DM. Cases were T2DM patients with an unprovoked treated VTE. The exposure of interest was glycemic control measured as HbA1c levels. We conducted conditional logistic regression analyses adjusted for several confounders.Results:We identified 3’896 VTE cases and 15’584 controls (56% females). We found no association between the HbA1c level and the risk of VTE in our main analysis. However, when the most recent HbA1c value was within 90 days before the index date, women with HbA1c levels > 7.0% had an 18–35% increased relative risk of VTE when compared to women with HbA1c > 6.5-7.0%.Conclusions:Our study raises the possibility that female T2DM patients with HbA1c levels > 7% may have a slightly higher risk for unprovoked VTE compared to women with HbA1c level > 6.5-7.0%. This increase may not be causal and may reflect differences in life style or other characteristics. We observed no effect of glycemic control on the risk of VTE in men.

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