Reduction in new-onset diabetes mellitus after renal transplant with erythropoietin-stimulating agents: a retrospective cohort study.
BACKGROUND
Studies have shown that erythropoietin-stimulating agents (ESAs) protect mice against the development of diabetes through direct effects on pancreatic ß cells. However, the effect of ESAs on the incidence of diabetes in humans has not been well studied. It is unknown whether exposure to ESAs is associated with a reduced incidence of new-onset diabetes after transplant (NODAT).


OBJECTIVE
The objective of this study is to examine the relationship between ESA exposure post-renal transplant and the development of NODAT.


METHODS
We performed a single center, retrospective cohort analysis.


METHODS
We compared patients who received a first live or deceased donor renal allograft, with any exposure to an ESA vs. those without such exposure and who developed NODAT and who did not. Patients with a prior history of diabetes mellitus or multi-organ transplant, including a second renal transplant were excluded.


METHODS
NODAT was defined based on the 2008 Canadian Diabetes Association criteria. Multivariate logistic regression analysis was performed to determine factors independently associated with NODAT.


RESULTS
One hundred thirty-two (29 %) patients were exposed to an ESA, four of which developed NODAT compared to 128 who did not develop NODAT (p < 0.0001). Of those not exposed to an ESA, 15 % (48/319) developed NODAT. By Fisher's exact test, exposure to an ESA at any time post-transplant reduced the risk of developing NODAT; odds ratio (OR) = 0.08, 95 % confidence interval (CI) (0.018-0.352), p = 0.0008. Older age; OR = 1.41, 95 % CI (1.036-1.933), p < 0.02, higher random blood sugar at discharge; OR = 1.30, 95 % CI (1.077-1.57), p < 0.006 and deceased donor; OR 2.18 CI (1.009-4.729), p = 0.04 were associated with an increased risk of NODAT.


CONCLUSIONS
The limitations of this study include its retrospective nature, single center, and homogenous population; thus, generalizability of the results must be approached with caution.


CONCLUSIONS
ESA exposure may be associated with a reduced incidence of NODAT in the post-renal transplant population. The role of ESA in preventing NODAT requires further investigation.
Renal Transplant Program, St. Michael's Hospital, 61 Queen Street East, 9th Floor, Toronto, ON Canada M5C 2T2 ; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Tess
T
Montada-Atin
Faculty of Medicine, University of Toronto, Toronto, Canada.
Diana
D
Choi
Endocrinology and Metabolism, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON Canada M5G 2C4 ; Division of Endocrinology, University of Toronto, Toronto, Canada ; Department of Medicine and Biophysics, University of Toronto, Toronto, Canada.
Minna
M
Woo
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, 60 Murray Street, Toronto, ON Canada M5T 3L9 ; Department of Medicine, University of Toronto, Toronto, Canada ; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
Ravi
R
Retnakaran
Renal Transplant Research, St. Michael's Hospital, 30 Bond Street, Toronto, ON Canada M5B 1W8.
Michael
M
Huang
Renal Transplant Program, St. Michael's Hospital, 61 Queen Street East, 9th Floor, Toronto, ON Canada M5C 2T2 ; Division of Nephrology, University of Toronto, Toronto, Canada.
G V Ramesh
GV
Prasad
Renal Transplant Program, St. Michael's Hospital, 61 Queen Street East, 9th Floor, Toronto, ON Canada M5C 2T2 ; Department of Medicine, University of Toronto, Toronto, Canada ; Division of Nephrology, University of Toronto, Toronto, Canada.
Jeffrey S
JS
Zaltzman
Diabetes; Erythropoietin; NODAT; Renal transplant