Obesity – Key risk factor for diabetes mellitus after kidney transplantation

Česká verzia

Authors: Ivana Dedinská ¹; Ľudovít Laca ¹; Juraj Miklušica ¹; Peter Galajda ²; Marián Mokáň ²
Authors place of work: Chirurgická klinika a transplantačné centrum Jesséniovej LF UK a Univerzitnej nemocnice Martin ¹; I. Interná klinika Jesséniovej LF UK a Univerzitnej nemocnice Martin ²
Published in the journal: Forum Diab 2015; 4(3): 191-194
Category: Main Theme: Review

Summary

Purpose:
New-onset diabetes mellitus after transplantation (NODAT) is a serious and frequent complication of solid organ transplantations. NODAT leads to 2–3 times higher cardiovascular morbidity and mortality. Visceral obesity is a key factor for diabetes mellitus type 2 and metabolic syndrome development and represents an independent risk factor for cardiovascular diseases.

Materials and methods:
The set consisted of 210 patients after primary kidney transplantation from a dead donor (90 patients had developed NODAT), average age of the set was 48.1 ± 9.9 years. We have examined age at the time of transplantation, body mass index at the time of transplantation. We have examined waist circumference, body mass index and weight gain in the 12th month after transplantation.

Results:
We have identified following independent risk factors for NODAT: age at the time of transplantation 50–59 years (HR = 2.5038 [95 % CI: 1.7179 to 3.6492], P < 0.0001), age at the time of transplantation higher than 60 years (HR = 1,1376 [95 % CI: 1,0437 – 1,23399], P < 0,0034), body mass index at the time of transplantation more than 30 kg/m²(HR = 1,5986 [95 % CI: 1,0650 – 2,3997], P < 0,0236), waist circumference in men greater than 94 cm (HR = 1,9492 [95 % CI: 1,1697 to 3,2480], P < 0,0104), ), in women greater than 80 cm (HR = 4,5018 [95 % CI: 1,8669 to 10,8553], P < 0,009). By using correlation coefficient we have proved that greater waist circumference related to higher incidence of NODAT (r = 0.1935, [95 % CI: 0.01156 to 0.3630], P = 0.0374).

Conclusion:
We have identified waist circumference as an independent risk factor for NODAT in our analysis. Regular weight and waist circumference control in patients after kidney transplantation leads to identification of risk patients for NODAT.

Key words:
body mass index – New-onset diabetes after transplantation – waist circumference – kidney transplantation

Zdroje

1. Davidson J, Wilkinson AH, Dantal J et al. New-onset diabetes after transplantation: 2003 International Consensus Guidelines. Transplantation 2003; 75(10): SS3-SS24.

2. Baid S, Cosimi AB, Farrel ML et al. Posttransplant diabetes mellitus in liver transplant recipients: risk factors, temporal relationship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation 2001; 72(6): 1066–1072.

3. Knobler H, Stagnaro-Green A et al. Higher incidence of diabetes in liver transplant recipients with hepatitis C. J Clin Gastroenterol 1998; 26(1): 30–33.

4. Ye X, Kuo H-T, Sampaio MS et al. Risk factors for the development of new-onset diabetes mellitus after transplant in adult lung transplant recipients. Clin Transplant 2011; 25(6): 885–891.

5. Hjelmesaeth J, Hartmann A, Leivestad T. The impact of early-diagnosed new-onset post-transplantation diabetes mellitus on survival and major cardiac events. Kidney Int 2006; 69(3): 588–595.

6. Kantárová D, Vrlík M, Buc M. Genetic determination and immunopathogenesis of type 1 diabetes mellitus in humans. Acta Medica Martiniana 2012; 12 (2): 19–31.

7. Cosio FG, Pesavento TE, Kim S et al. Patient survival after renal transplantation: IV. Impact of post-transplant diabetes. Kidney Int 2002; 62(4): 1440–1446.

8. Porrini E, Delgado P, Torres A. Metabolic syndrome, insulin resistance, and chronic allograft dysfunction. Kidney Int Suppl 2010; (119): S42–S46.

9. Moon JI, Barbeito R, Faradji RN et al. Negative impact of new onset diabetes mellitus on patient and graft survival after liver transplantation: long-term follow-up. Transplantation 2006; 82(12): 1625–1628.

10. John PR, Thuluvath PJ. Outcome of patients with new-onset diabetes mellitus after liver transplantation compared with those without diabetes mellitus. Liver Transpl 2002; 8(8): 708–713.

11. Ollech JE, Kramer MR, Peled N et al. Post-transplant diabetes mellitus in lung transplant recipients: incidence and risk factors. Eur J Cardiothorac Surg. 2008; 33(5): 844–848.

12. The IDF worldwide definition of the metabolic syndrome. International diabetes federation: 2006. Dostupné z WWW: <https://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf>.

13. Galajda P, Mokáň M. Problematika etiopatogenézy a diagnostiky metabolického syndrómu. Diabetes a obezita 2004; 4(7): 39–49.

14. Vojtková J, Ďurdík P, Michnová Z et al. Exhaled carbon monoxide in adolescents with diabetic cardiovascular autonomic neuropathy. J Pediatr Endocrinol Metab 2014; 27(7–8): 709–715.

15. Cosio FG, Pesavento TE, Osei K et al. Post-transplant diabetes mellitus: increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int 2001; 59(2): 732–737.

16. Kasiske BL, Snyder JJ, Gilbertson D et al. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant 2003; 3(2): 178–185.

17. Czernichow S, Kengne AP, Stamatakis E et al. Body mass index, waist circumference and waist–hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obes Rev 2011; 12(9): 680–687.

18. Kodgire S, Varughese S, Basu G et al. Clinical profile of New Onset Diabetes Mellitus After Transplant (NODAT) in renal allograft recipients. Moderated Poster Session: Clinical Studies in Renal Transplantation 2013.

19. Meier-Kriesche HU, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: A significant independent risk factor for graft failure and patient death. Transplantation 2002; 73(1): 70–74.

20. Clunk JM, Lin CY, Curtis JJ. Variables affecting weight gain in renal transplant recipients. Am J Kidney Dis 2001; 38(2): 349–353.

21. Potluri K, Hou S. Obesity in kidney transplant recipients and candidates. Am J Kidney Dis 2010; 56(1): 143–156.

22. Cashion AK, Sanchez ZV, Cowan PA et al. Changes in weight during the first year after kidney transplantation. Prog Transplant 2007; 17(1): 40–47.

23. Leavey SF, McCullough K, Hecking E et al. Body mass index and mortality in ‘healthier’ as compared with ‘sicker’ haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2001; 16(12): 2386–2394.

24. Salahudeen AK. Obesity and survival on dialysis. Am J Kidney Dis 2003; 41(5): 925–932.

25. Wilkinson A, Davidson J, Dotta F. Guidelines for the treatment and management of new-onset diabetes after transplantation. Clin Transplant 2005; 19(3): 291–298.