title: Evolution of tacrolimus blood levels and concentration-dose ratios in patients who develop new onset diabetes mellitus after kidney transplantation.
abstract: New onset diabetes mellitus (NODM) affects kidney transplantation outcome. Several risk factors, including immunosuppressive drug levels, are related with NODM development. This analysis evaluates the incidence and risk factors of NODM in kidney transplant patients receiving tacrolimus, taking into account 6-month blood levels and concentration-dose ratios (CDRs). Seventy-six patients under tacrolimus therapy who received a cadaveric renal transplant in our centre and with graft survival higher than 1 year were included in the study. NODM was defined as two fasting plasma glucose values > or =126 mg/dl or symptoms of diabetes plus casual plasma glucose concentrations > or =200 mg/dl throughout the first year. We examined previously reported variables related with NODM development. The incidence of NODM at 12 months was 27.6%. Risk factors for NODM included older age, higher first tacrolimus level, higher body mass index and lower first year weight gain. In multivariate analysis, the first year occurrence of NODM was significantly determined by the first tacrolimus blood level >20 ng/ml and age older than 50 years. CDR remains significantly higher in NODM throughout the 6 months. Older age and a high first tacrolimus blood level are associated with the development of NODM during the first year after kidney transplantation. NODM patients show higher CDR during the first 6 months.
authors.affiliation: Department of Nephrology, Hospital Marqués de Valdecilla, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain. nefrce@humv.es
authors.forename: Emilio
authors.initials: E
authors.lastname: Rodrigo
authors.forename: Celestino
authors.initials: C
authors.lastname: Piñera
authors.forename: María Angeles
authors.initials: MA
authors.lastname: de Cos
authors.forename: Blanca
authors.initials: B
authors.lastname: Sánchez
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ruiz
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Fresnedo
authors.forename: Rosa
authors.initials: R
authors.lastname: Palomar
authors.forename: Julio
authors.initials: J
authors.lastname: González-Cotorruelo
authors.forename: Carlos
authors.initials: C
authors.lastname: Gómez-Alamillo
authors.forename: Saturnino Sanz
authors.initials: SS
authors.lastname: de Castro
authors.forename: Angel Luis Martín
authors.initials: AL
authors.lastname: de Francisco
authors.forename: Manuel
authors.initials: M
authors.lastname: Arias
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002102:Cadaver; D048909:Diabetes Complications / Q000209:etiology; D003920:Diabetes Mellitus / Q000097:blood / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007118:Immunoassay; D007166:Immunosuppressive Agents / Q000097:blood / Q000493:pharmacokinetics*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016559:Tacrolimus / Q000097:blood / Q000493:pharmacokinetics*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007166:Immunosuppressive Agents; D016559:Tacrolimus