Early clinical assessment of glucose metabolism in renal allograft recipients: diagnosis and prediction of post-transplant diabetes mellitus (PTDM).
BACKGROUND
Post-transplant diabetes mellitus (PTDM) has serious consequences for renal allograft survival, cardiovascular risk and patient survival.


METHODS
The predictive value of a fasting plasma glucose (FPG) level and oral glucose tolerance test (OGTT) on the fifth day post-transplantation were prospectively evaluated in 359 de novo renal allograft recipients. PTDM was defined as the uninterrupted need for glucose-lowering medication for at least 3 months.


RESULTS
Sixty-four patients (17.8%) developed PTDM (follow-up 42.8 +/- 16.9 months). Recipient age, body mass index (BMI), biopsy-proven acute rejection (BPAR), early graft function and proteinuria, tacrolimus-based therapy, cumulative corticosteroid dose and thiazide diuretics were associated with PTDM (univariate analysis). Multivariate logistic regression analysis identified age [OR (odds ratio): 1.05 (95% confidence interval: 1.019-1.083)], BMI [OR: 1.09 (1.013-1.189)], proteinuria on Day 5 [OR: 1.51 (1.043-2.210)] and BPAR [OR: 2.74 (1.345-5.604)] as independent risk factors for PTDM while a normal OGTT on Day 5 post-transplantation was associated with a strongly reduced risk for PTDM [OR: 0.03 (0.008-0.166)]. A similar risk reduction was conferred by a normal FPG on Day 5 [OR: 0.06 (0.012-0.338)]. OGTT had the best sensitivity (93.4%) and specificity (71.9%) with a high negative predictive value (97.6%).


CONCLUSIONS
The Day 5 OGTT is an independent predictor of PTDM that can be used for identifying recipients at reduced risk for PTDM, taking into account the impact of independent clinical risk factors like age, BMI and BPAR (treatment). This information can help clinicians in directing therapeutic management of modifiable risk factors for PTDM after renal transplantation.
Kuypers
Dirk R J
DR
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, University of Leuven, Belgium. Dirk.kuypers@uz.kuleuven.ac.be
Claes
Kathleen
K
Bammens
Bert
B
Evenepoel
Pieter
P
Vanrenterghem
Yves
Y
D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000188:drug therapy; D042241:Early Diagnosis; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors; D014184:Transplantation, Homologous
D001786:Blood Glucose; D007004:Hypoglycemic Agents