Post-transplant diabetes de NOVO (NODAT) in a Paraguayan kidney transplant population: prevalence and risk factors
Juan Acosta1, Adriana C Martínez1, Pablo Jara1, María G Orue1, María M Mayor 1, Alba L Benítez1, María del Carmen Romero1, Roger A Ayala1.
1Nephrology, Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
Introduction and Objectives: NODAT is a well-recognized complication of solid organ transplantation. Its prevalence in Paraguay is unknown. The objective of this study was to determine the prevalence of NODAT in a kidney transplant population of Paraguay and to identify contributing risk factors.
Materials and Methods: Retrospective, descriptive, observational study with an analytical component. From February 2010 to January 2020, 77 first kidney transplants were performed at our institution. The patients included were ≥18 years old, 10 patients were excluded for being DM2. The variables studied were: sex, age, BMI, abdominal circumference, family history of DM2, etiology of CKD, type of donor and immunosuppression used, lipid profile, renal function, and proteinuria at discharge and one year after transplant.
Results: Of the 67 recipients, 49/67 (73.1%) were male, age 45.1 ± 11.6 years; in 36/67 (53.7%) the etiology was unknown, family history of DM2 present in 4/67 (5.9%). The donors were cadaveric in 54/67 (80.5%), tacrolimus (Tac) was the preferred calcineurin in 62/67 (92.5%). Glycemia at 12 months had a significant increase with p= 0.0007. Overweight and type I and II obesity were present in 38.8% and 22.3%, respectively, one year after the transplant and presented a statistically significant difference with the BMI at discharge with a p= 0.0041. The other variables did not present significant differences in the two cuts made. NODAT developed in 10/67 (14.9%) patients; in this population, 89.5% were male, mean age 53.6 years, 85.7% received cadaveric donation, all received CT scan and none had hypomagnesemia. Overweight and type I and II obesity were present in 50% and 30%, respectively. LDL cholesterol was 147.1 ± 26.2 mg/dL, median renal function was 62 mL/min/1.73 m2, and median proteinuria was 180 mg/day.
Conclusion: The prevalence of NODAT was 14.9% in 10 years. Those who developed it were men, with a mean age of 53.1 years, with a transplant from a cadaveric donor and Tac was the most used drug. Most had body mass index of overweight/obesity and hyperlipidemia. There was no correlation with hypomagnesemia. The renal function of the graft was not affected at one year of follow-up in these patients.
Keywords: De novo post-transplant diabetes (NODAT), kidney transplant, tacrolimus.
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