scholarly journals Obesity and Post-Transplant Diabetes Mellitus in Kidney Transplantation

2021 ◽  
Vol 10 (11) ◽  
pp. 2497
Author(s):  
Paloma Leticia Martin-Moreno ◽  
Ho-Sik Shin ◽  
Anil Chandraker
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Weight Loss ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Post Transplant ◽  
Transplant Patients ◽  
Current State ◽  
Immunosuppressive Medications ◽  
Before And After

Worldwide, the prevalence obesity, diabetes, and chronic kidney disease is increasing apace. The relationship between obesity and chronic kidney disease is multidimensional, especially when diabetes is also considered. The optimal treatment of patients with chronic kidney disease includes the need to consider weight loss as part of the treatment. The exact relationship between obesity and kidney function before and after transplantation is not as clear as previously imagined. Historically, patients with obesity had worse outcomes following kidney transplantation and weight loss before surgery was encouraged. However, recent studies have found less of a correlation between obesity and transplant outcomes. Transplantation itself is also a risk factor for developing diabetes, a condition known as post-transplant diabetes mellitus, and is related to the use of immunosuppressive medications and weight gain following transplantation. Newer classes of anti-diabetic medications, namely SGLT-2 inhibitors and GLP-1 agonists, are increasingly being recognized, not only for their ability to control diabetes, but also for their cardio and renoprotective effects. This article reviews the current state of knowledge on the management of obesity and post-transplant diabetes mellitus for kidney transplant patients.

Abstract 234: Changes in Plasma Nitration of High-Density and Low-Density Lipoproteins in Patients With Chronic Kidney Disease Receiving Kidney Transplants

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Ahmed Bakillah ◽  
Fasika Tedla ◽  
Isabelle Ayoub ◽  
Devon John ◽  
Allen Norin ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipid Lowering ◽  
Elevated Concentration ◽  
Low Density ◽  
Post Transplant ◽  
Transplant Patients

Background: Functional abnormalities of high-density lipoprotein (HDL) and elevated concentration of low-density lipoprotein (LDL) could contribute to cardiovascular disease (CVD) in chronic kidney disease (CKD) patients. Both qualitative and quantitative changes in HDL have been described in patients with CKD. Specifically, HDL abundance is reduced and HDL acquires a pro-inflammatory properties. In this study, we hypothesized that a functioning kidney transplant reduces serum nitrated apoA-I concentration. Methods: Concentrations of nitrated apoA-I, nitrated apoB, total apoA-I and total apoB were measured using indirect sandwich ELISA on sera collected from each transplant subject pre-transplant and at 1, 3, and 12 months post-transplant. Patients were excluded if they had a history of diabetes, prednisone dose > 15 mg/day, nephrotic range proteinuria, serum creatinine (Cr) > 1.5mg/dL or active inflammatory disease, or were treated with lipid-lowering medication or HIV protease inhibitors. Paired values of percent nitrated Apo A-I or nitrated apoB before and after kidney transplantation were compared using Wilcoxon signed rank sum test. Results: We screened 75 transplant patients, and 14 were found to meet the selection criteria. Amongst these patients, twelve and eight patients had Cr < 1.5 mg/dL at 3 and 12 months post-transplant, respectively. There was a significant reduction in % nitrated apoA-I at 12 months post-transplant compared to pre-transplant values in patients with Cr<1.5 mg/dL (p=0.04) but neither at 3 months post-transplant nor in patients with Cr >1.5. Reduction of nitrated apoA-I was associated with slight increase in HDL levels 12 months post-transplantation. In contrast to apoA-I, there was no significant change in % nitrated apoB at 3 months and 12 months post-transplant. No significant corelation was observed between nitrated lipoproteins and CRP levels. Conclusion: Patients with well functioning grafts had significant reduction in percent nitrated apoA-I without any effect on apoB nitration 12 months after kidney transplantation. Further studies are needed in a large cohort to determine if nitrated apoA-I can be used as a valuable marker for cardiovascular risk stratification in CKD.

scholarly journals Quality of life and spirituality of patients with chronic kidney disease: pre- and post-transplant analysis

2020 ◽  
Vol 73 (suppl 5) ◽  
Author(s):  
Letícia Meazzini de Olivera ◽  
Meiry Fernanda Pinto Okuno ◽  
Dulce Aparecida Barbosa ◽  
Ricardo de Castro Cintra Sesso ◽  
Gerson Scherrer Júnior ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Kidney Transplant ◽  
Disease Burden ◽  
Four Dimensions ◽  
Post Transplant ◽  
Transplant Patients

ABSTRACT Objective: to compare the quality of life (QoL) of patients under dialysis and after kidney transplant; correlate the QoL of transplant patients to sociodemographic, morbid and spirituality/religiosity variables. Method: prospective study with a quantitative approach, with a sample of 27 patients who underwent peritoneal dialysis or dialysis undergoing kidney transplant. QoL and spirituality were assessed by the KDQOL-SF and WHOQOL-SRPB tools, being correlated with sociodemographic and economic variables. Results: the dimensions of total mental component, kidney disease effects and kidney disease burden showed significant improvement in the post-transplant period, with p <0.0004. There was a significant correlation between four dimensions of spirituality and seven dimensions of QoL; p ranged from 0.04 to 0.006. Conclusion: there was a significant improvement in QoL in the post-transplant period. The dimensions of spirituality: wholeness and integration, spiritual connection, wonder and inner peace were positively correlated with seven dimensions of QoL.

Renal function status in liver transplant patients in the first month post-transplant is associated with progressive chronic kidney disease

2014 ◽  
Vol 45 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Kazushige Sato ◽  
Naoki Kawagishi ◽  
Keisei Fujimori ◽  
Noriaki Ohuchi ◽  
Susumu Satomi
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Liver Transplant ◽  
Post Transplant ◽  
Transplant Patients

scholarly journals Association of Inflammation prior to Kidney Transplantation with Post-Transplant Diabetes Mellitus

2016 ◽  
Vol 6 (4) ◽  
pp. 289-300 ◽  
Author(s):  
Maria P. Martinez Cantarin ◽  
Scott W. Keith ◽  
Zhao Lin ◽  
Cataldo Doria ◽  
Adam M. Frank ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Adipose Tissue ◽  
Kidney Transplantation ◽  
Mrna Expression ◽  
Glucose Uptake ◽  
Fold Change ◽  
C2c12 Cells ◽  
Post Transplant ◽  
Transplant Patients

Background/Objective: Post-transplant diabetes mellitus (PTDM) is both common and associated with poor outcomes after kidney transplantation. Our objective was to examine relationships of uremia-associated inflammation and adiponectin with PTDM. Methods: Nondiabetic kidney transplant patients were enrolled with donor controls. Inflammatory cytokines and adiponectin were measured before and after transplantation. Adipose tissue was obtained for gene expression analysis. Glucose transport was quantified in vitro in C2C12 cells following cytokine exposure. The patients were monitored up to 12 months for PTDM. Results: We studied 36 controls and 32 transplant patients, of whom 11 (35%) developed PTDM. Compared to controls, plasma TNFα, IL-6, MCP-1, and CRP levels were higher in transplant patients (p < 0.01). In multivariable analysis, TNFα plasma levels before transplantation were associated with development of PTDM (OR = 2.03, p = 0.04). Visceral adipose tissue TNFα mRNA expression was higher in transplant patients than controls (fold change 1.33; p < 0.05). TNFα mRNA expression was also higher in patients who developed PTDM than in those who did not (fold change 1.42; p = 0.05), and adiponectin mRNA expression was lower (fold change 0.48; p < 0.05). The studies on the C2C12 cells demonstrated an increase in glucose uptake following exposure to adiponectin and no significant change after exposure to TNFα alone. Concomitant TNFα and adiponectin exposure blunted adiponectin-induced glucose uptake (11% reduction; p < 0.001). Conclusion: Our in vitro and clinical observations suggest that TNFα could contribute to PTDM through an effect on adiponectin. Our study proposes that inflammation is involved in glucose regulation after kidney transplantation.

scholarly journals Pre-Transplant Obesity and Post-Transplant Chronic Kidney Disease: Time-Dependent Effect of Kidney Transplantation

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1251-1251
Author(s):  
Ekamol Tantisattamo ◽  
Natnicha Leelaviwat ◽  
Natsuki Eguchi ◽  
Natchaya Polpichai ◽  
Natsumon Udomkittivorakul ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Time Dependent ◽  
Obese Group ◽  
Dependent Effect ◽  
Post Transplant ◽  
Allograft Function ◽  
Time Dependent Effect

Abstract Objectives Obesity is associated with worsening kidney allograft function. Since kidney allograft function may rapidly change throughout the course of kidney transplantation, particularly during early post-transplant period, we aim to examine association between pre-transplant obesity and development of chronic kidney disease (CKD) over several time points during post-transplant periods. Methods A single center retrospective cohort study included kidney transplant recipients who received kidney transplantation, between 2012 and 2015. The study population were divided into non-obese and obese groups based on pre-transplant body mass index (BMI) of &lt; 30 and ≥30 kg/m2, respectively. Association between the obesity status and post-transplant CKD defined as estimated glomerular filtration rate (eGFR) &lt; 60 ml/min/1.73 m2 was examined by multivariable Cox proportional hazard regression analysis with a time-dependent effect at 12, 24, 36, and 48 weeks post-kidney transplantation. Results Of all 105 patients, mean age ± SD was 54 ± 12 and 61% was female. Non-obese and obese groups were account for 64% and 36%, respectively and their corresponding mean BMI were 24.34 ± 3.54 and 34.27 ± 3.53 kg/m2 (P &lt; 0.001). The risk of developing CKD at 12, 36, and 48 weeks post-kidney transplantation, were not significantly difference. However, at 24-week post- kidney transplantation, obese group had 71% greater the risk for CKD compared to non-obese group (Hazard ratio (HR) 1.71, P 0.049, 95% confidence interval (95%CI) 1.002, 2.908). After adjusted for age, gender, type of kidney transplantation, systolic and diastolic blood pressure at 24 weeks post-kidney transplantation, the obese group remain at higher the risk for CKD (HR 1.74, P 0.044, 95% CI 1.014, 2.985). Conclusions Pre-kidney transplant obesity was associated with increased risk of CKD at the early, but not at the immediate or long-term post-transplant periods independent to the baseline characteristics and blood pressure. Pathophysiological changes during different post-transplant periods including immunological or non-immunological factors may contribute to this time-dependent effects of pre-transplant obesity and CKD. Additional studies are warranted to further examine possible mechanism. Funding Sources None.

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