1. bookVolume 75 (2021): Issue 2 (April 2021)
Journal Details
License
Format
Journal
First Published
14 Sep 2008
Publication timeframe
6 times per year
Languages
English
access type Open Access

Early Correction of Post-Kidney Transplant Hyperglycaemia is Associated with Reduction of the Prevalence of Post-Transplant Diabetes Mellitus

Published Online: 08 May 2021
Page range: 99 - 105
Received: 09 Jul 2020
Accepted: 13 Jan 2021
Journal Details
License
Format
Journal
First Published
14 Sep 2008
Publication timeframe
6 times per year
Languages
English
Abstract

Our study was focused on identification and correction of early hyperglycaemia, with the aim to reduce the risk of developing post-transplant diabetes mellitus (PTDM) and its associated complications. In a single centre, the prospective study included adult kidney transplant recipients without diabetes mellitus whose pre-transplant glucometabolic data did not show signs of diabetes mellitus. Starting from the first day after kidney transplantation, patients were closely monitored for hyperglycaemia; glucose level measurements were started to obtain pre-prandial levels. If the blood glucose level exceeded 11.1 mmol/l, hyperglycaemia was corrected with short-acting insulin. A total of 14 patients completed a three-month follow-up. During the first post-transplant week, the blood glucose level exceeded 11.1 mmol/l in nine patients (63.9%). From those patients five (55.5%) did not develop PTDM. None of the patients who did not need insulin treatment developed PTDM. Higher pre-lunch glucose levels increased the risk of developing PTDM (p = 0.006). Patients with diabetes required a two times higher insulin dosage than other patients during the first post-transplantation week. We found that hyperglycaemia is a common problem in the early post-transplant period. Early recognition and correction of inpatient hyperglycaemia was associated with reduction of the prevalence of PTDM in more than a half of the patients in the studied group at three months post transplant.

Keywords

Bonato, V., Barni, R., Cataldo, D., Collini, A., Ruggieri, G., De Bartolomeis, C., Dotta, F., Carmellini, M. (2008). Analysis of post transplant diabetes mellitus prevalence in a population of kidney transplant recipients. Transplant Proc.,40, 1888–1890.Search in Google Scholar

Chakkera, H. A., Knowler, W. C., Devarapalli, Y., Weil, E. J., Heilman, R. L., Dueck, A., Mulligan, D. C., Reddy, K. S., Moss, A. A., Mekeel, K. L., Mazur, M. J., Hamawi, K., Castro, J. C., Cook, C. B. (2010). Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus. Clin. J. Amer. Soc. Nephrol.,5 (9), 1669–1675.Search in Google Scholar

Chakkera, H. A., Weil, E. J., Castro, J., Heilman, R. L., Reddy, K. S., Mazur, M. J., Hamawi, K., Mulligan, D. C., Moss, A. A., Mekeel, K. L., Cosio, F. G., Cook, C. B. (2009). Hyperglycemia during the immediate period after kidney transplantation. Clin. J. Amer. Soc. Nephrol.,4 (4), 853–859.Search in Google Scholar

Cosio, F. G., Kudva, Y., van der Velde, M., Larson, T. S., Textor, S. C., Griffin, M. D., Stegall, M. D. (2005). New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. Kidney Int., 6 (67), 2415–2421.Search in Google Scholar

Cosio, F. G., Pesavento, T. E., Kim, S., Osei, K., Henry, M., Ferguson, R. M. (2002). Patient survival after renal transplantation: IV. Impact of post-transplant diabetes. Kidney Int.,62, 1440–1446.Search in Google Scholar

Kuypers, D. R. J., Claes, K., Bammens, B., Evenepoel, P., Vanrenterghem, Y., Early clinical assessment of glucose metabolism in renal allograft recipients: Diagnosis and prediction of post-transplant diabetes mellitus (PTDM). Nephrol. Dial. Transplant.,23 (6), 2033–2042.Search in Google Scholar

Ducloux, D., Kazory, A., Chalopin, J. M. (2005). Posttransplant diabetes mellitus and atherosclerotic events in renal transplant recipients: A prospective study. Transplant,79, 438–443.Search in Google Scholar

Rodrigo, E., Santos, L., Piñera, C., Quintanar, J. A., Ruiz, J. C., Fernandez-Fresnedo, G., Palomar, R., Gomez Alamillo, C., Arias, M. (2011). Early prediction of new-onset diabetes mellitus by fifth-day fasting plasma glucose, pulse pressure, and proteinuria. Transplant Proc., 43, 2208–2210.Search in Google Scholar

Gomes, V., Ferreira, F., Guerra, J., Bugalho, M. J. (2018). New-onset diabetes after kidney transplantation: Incidence and associated factors. World J. Diabetes,9 (7), 132–137.Search in Google Scholar

Hecking, M., Haidinger, M., Döller, D., Werzowa, J., Tura, A., Zhang, J., Tekoglu, H., Pleiner, J., Wrba, T., Rasoul-Rockenschaub, S., et al. (2012). Early basal insulin therapy decreases new-onset diabetes after renal transplantation. J. Amer. Soc. Nephrol., 23 (4), 739–749.Search in Google Scholar

Hjelmesaeth, J., Hartmann, A., Kofstad, J., Egeland, T., Stenstrom, J., Fauchald, P. (2001). Tapering off prednisolone and cyclosporin the first year after renal transplantation: The effect on glucose tolerance. Nephrol. Dial Transplant, 16, 829–835.Search in Google Scholar

Jenssen, T., Hartmann, A. (2019). Post-transplant diabetes mellitus in patients with solid organ transplants. Nat. Rev. Endocrinol., 15, 172–188.Search in Google Scholar

Kasiske, B. L., Snyder, J. J., Gilbertson, D., Matas, A. J. (2003). Diabetes mellitus after kidney transplantation in the United States. Amer. J. Transplant, 3, 178–185.Search in Google Scholar

Palepu, S., Prasad, G. V. (2015). New-onset diabetes mellitus after kidney transplantation: Current status and future directions. World J. Diabetes,6 (3), 445–455.Search in Google Scholar

Sharif, A., Cohney, S. (2016). Post-transplantation diabetes — state of the art. Lancet Diabetes Endocrinol.,4 (4), 337–349.Search in Google Scholar

Shimada, H., Uchida, J., Nishide, S., Kabei, K., Kosoku, A., Maeda, K., Iwai, T., Naganuma, T., Takemoto, Y., Nakatani, T. (2019). Comparison of glucose tolerance between kidney transplant recipients and healthy controls. J. Clin. Med., 8 (7), 920.Search in Google Scholar

Shivaswamy, V., Boerner, B., Larsen, J. (2016). Post-transplant diabetes mellitus: Causes, treatment, and impact on outcomes. Endocrin. Rev.,37 (1), 37–61.Search in Google Scholar

Wojtuscizin, A., Mourad, G., Bringer, J., Renard, E. (2013). Continuous glucose monitoring after kidney transplantation in non-diabetic patients: Early hyperglycaemia is frequent and may herald post-transplantation diabetes mellitus and graft failure, Diabetes Metabolism,39, 404–410.Search in Google Scholar

Woodward, R. S., Schnitzler, M. A., Baty, J., Lowell, J. A., Lopez Rocafort, L., Haider, S., Woodworth, T. G., Brennan, D. C. (2003). Incidence and cost of new onset diabetes mellitus among U.S. wait-listed and transplanted renal allograft recipients. Amer. J. Transplant,3, 590–598.Search in Google Scholar

Recommended articles from Trend MD

Plan your remote conference with Sciendo