Predictors of metabolic syndrome following one-year post kidney transplantation among Vietnamese patients
Nguyen Thu Ha1,4, Poh Bee Koon1, Zulfitri Azuan Mat Daud2, Rozita Mohd3, Ruzita Abd. Talib1, Ho Trung Hieu4.
1Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 2Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Kuala Lumpur, Malaysia; 3Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 4108 Military Central Hospital, Hanoi, Viet Nam
Background: Metabolic syndrome (MS) contributes to excess graft failure and poor survival of kidney recipients and, hence, becomes an important clinical target following kidney transplantation. This study aims to determine factors associated with increased risk of MS events in Vietnamese kidney transplant patients.
Methods: We conducted a single-centre cohort study among 104 patients receiving a first kidney transplant at a hospital in Vietnam. MS was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III and diagnosed after 1-month to 1-year post-transplant. Multivariable Cox proportional hazards models were applied to detect potential risk factors for MS.
Results: A total of 75 patients completed one-year follow up post-transplantation with 53.3% (n=40) presenting with MS. Mean age of patients was 41.9±11.6-year-old, and the average duration of renal replacement therapy was 27.9±41.1 months. Prevalence of overweight was 4.0%, 69.3% hypertension, 54.7% low HDL-C, 94.7% hypertriglyceridemia, and 89.3% had hyperglycemia. Patients with hyperglycemia and low HDL-C before the transplantation had a significantly higher risk for MS later (OR 4.74, 95%CI 1.60 – 14.06 and OR 7.33, 95%CI 1.40 – 38.34, respectively). In the multivariable Cox proportional hazards, BMI (HR 0.87, 95%CI 0.78 – 0.97); serum calcium (HR 0.15, 95%CI 0.04 – 0.56); serum albumin (HR 1.25, 95%CI 1.12 – 1.40); triglyceride (HR 1.41 95%CI 1.07 – 1.86); blood level of tacrolimus (HR1.15, 95%CI 1.06 – 1.25); and mycophenolate mofetil (HR 1.003, 95%CI 1.002 – 1.005) were associated with increased risk of MS.
Conclusion: Our results suggest that the presence of low HDL-C and hyperglycemia before kidney transplantation, are independent risk factors for MS in Vietnamese kidney transplant patients. MS is associated with BMI, serum calcium, albumin, triglyceride, the high blood level of tacrolimus and dose of mycophenolate mofetil. Interventions aimed at improving these factors before and after the transplantation may reduce the incidence of metabolic syndrome.
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