title: New-onset diabetes after transplantation: drug-related risk factors.
abstract: BACKGROUND
  New-onset diabetes after transplantation (NODAT), an important complication of renal transplantation leads to reduced graft function and increased patient morbidity and mortality. Because of its high incidence and immense impact on clinical outcomes, prevention of NODAT is highly desirable. Several modifiable and nonmodifiable risk factors for NODAT have been described. The aim of this study was to analyze the influence of various drugs on the development of NODAT during the first year.
  
  
  METHODS
  A retrospective analysis was performed on 303 adult kidney transplant recipients free of previously known diabetes. NODAT was defined as a fasting plasma glucose level ≥ 126 mg/dL confirmed by repeat testing on a different day. We excluded patients with transiently elevated fasting plasma glucose during the first 3 months.
  
  
  RESULTS
  NODAT was diagnosed in 37 recipients (12.2%). Univariate analysis identified several variables related to NODAT: recipient age (P < .001), body mass index (P < .001), donor age (P = .005), family history of diabetes (P < .001), statin use (P = .005), diuretic use (P = .040) and tacrolimus therapy (P = .029). After multivariate analysis, recipient age (relative risk [RR] = 1.060, 95% confidence interval [CI] 1.019- 1.102, P = .004), family history of diabetes (RR = 3.562, 95% CI 1.574-8.058, P = .002), smoking habit (RR 2.514, 95% CI 1.118-5.655, P = .026) and diuretic use (RR = 2.496, 95% CI 1.087-5.733, P = .031) were independently associated with NODAT development.
  
  
  CONCLUSIONS
  In our population of kidney transplant recipients, the main nonmodifiable risk factors for NODAT were recipient age and a family history of diabetes. Diuretic use was a modifiable risk factor associated with the development of NODAT. To reduce NODAT incidence, it is necessary to consider not only immunosuppressive therapy, but also concomitant drugs such as diuretics.
authors.affiliation: Nephrology Service, Hospital Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain. li-santos@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: Santos
authors.forename: E
authors.initials: E
authors.lastname: Rodrigo
authors.forename: C
authors.initials: C
authors.lastname: Piñera
authors.forename: E
authors.initials: E
authors.lastname: Quintella
authors.forename: J C
authors.initials: JC
authors.lastname: Ruiz
authors.forename: G
authors.initials: G
authors.lastname: Fernández-Fresnedo
authors.forename: R
authors.initials: R
authors.lastname: Palomar
authors.forename: C
authors.initials: C
authors.lastname: Gómez-Alamillo
authors.forename: A
authors.initials: A
authors.lastname: de Francisco
authors.forename: M
authors.initials: M
authors.lastname: Arias
mesh_terms: D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016559:Tacrolimus / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D004232:Diuretics; D007166:Immunosuppressive Agents; D016559:Tacrolimus