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Submitted: 19 April 2007 Modified: 20 August 2018
HERDIN Record #: PCHRD041807010453

Incidence of new-onset diabetes mellitus among Filipino renal allograft recipients.

Alvin Young,
Teresa Plata-Que

BACKGROUND: New-onset diabetes mellitus following renal transplantation is a frequent and serious complication that is associated with poor graft and patient survival. The incidence and clinical correlates of post-transplant diabetes mellitus (PTDM) in the Filipino renal transplant population has not been examined and may vary based on differences in demographics.


OBJECTIVES: To determine the one-year incidence of PTDM and its risk factors, and to compare the acute rejection rate within 6 months of patients who developed PTDM versus those without diabetes mellitus.


STUDY DESIGN: Retrospective cohort


STUDY SETTING: Tertiary, specialty hospital for renal diseases and transplantation


PATIENTS & METHODS: This cohort study included 296 patients who received a kidney transplant from 2002 to 2003. Follow-up was at least 12 months post-transplant. Predisposing factors to PTDM were determined including recipients age, body mass index (BMI), family history of diabetes mellitus, history of gestational diabetes and pre-transplant anti-HCV status; transplant variables such as immunosuppressive regimen, donor source, whether living or cadaver. Fasting blood glucose at months 1, 3, 6 and 12 post-transplant, and serum creatinine at months 6 and 12 were noted. Univariate analysis was performed to test for association and difference between two variables.


RESULTS: The one-year incidence of PTDM among Filipino renal allograft recipients was 15.5 percent. Among the Immunosuppressive treatment groups, 283 (95.6 percent) received cyclosporine; 9 (3 percent) received tacrolimus and only 4 (1.3 percent) received sirolimus. Among patients receiving calcineurin inhibitors, there was a greater trend Of developing PTDM in patients on tacrolimus than in patients given cyclosporine (62.5 percent vs 13.7 percent, p <0.0001), although a firm association was not established because of the small sample size of the tacrolimus group. The following factors were associated with a higher incidence of developing PTDM: BMI>25 (35 percent vs 10.2 percent, OR= 4.75, 95 percent confidence interval 2.25 - 9.92, p<0.001), positive antibodies to HCV (45 percent VS 14.4 percent, OR= 4.96, 95 percent confidence interval 1.13 - 20.35, p=0.005 ), positive family history of DM (39.34 percent VS 9.4 percent, OR= 6.28, 95 percent confidence interval 3.01 - 13.022, p<0.0001) and positive history of Gestational Diabetes (p<0.0001). Acute allograft rejection within the first 6 months post-transplant occurred in 41 percent of those who developed PTDM compared to 23.7 percent of those who did not develop diabetes (p=0.013). Recipients' age (40) and donor kidney source (living vs cadaver) were not found to be significant factors in the development of PTDM.


CONCLUSION: There are many risk factors in the development of PTDM. They should be recognized during the pre-transplant evaluation period so that the complication is recognized early and treated adequately after transplantation. Its development is associated with an increased risk of acute graft rejection.

Publication Type
Journal
Publication Sub Type
Announcements
Title
Philippine Journal of Nephrology
Frequency
Semi-Annual
Publication Date
January-June 2005
Volume
20
Issue
1
Page(s)
17-22
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Fulltext pdf (Request Document)
Philippine Council for Health Research and Development Box No. 53 Fulltext Print Format (Request Document)

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