Body Mass Index and the Development of New-Onset Diabetes Mellitus or the Worsening of Pre-Existing Diabetes Mellitus in Adult Kidney Transplant Patients

摘要

Objective: The purpose of this study was to determine the relationship between body mass index (BMI) and the development of new-onset diabetes after transplant (NODAT) as well as the worsening of pre-existing diabetes mellitus (DM) in adults after kidney transplantation. Design and Subjects: A medical record review was conducted using the records of 204 adult patients who underwent a first renal transplant between September 2009 and February 2011 at a single transplant center. Patients who received simultaneous transplantation of another organ, who were immunosuppressed for nontransplant reasons, or those who were less than 18years of age were excluded. Main Outcome Measures: Outcome data collected at the time of hospital discharge and at 3, 6, and 12months after kidney transplantation included the development of NODAT and the components of DM treatment regimens. Results: The cumulative incidence of NODAT at discharge and 3, 6, and 12months post-transplantation was 14.2%, 19.4%, 20.1%, and 19.4%, respectively. The odds of developing NODAT by discharge or 3 or 6months post-transplantation increased by a factor of 1.11 (95% confidence interval [CI]: 1.0-1.23), 1.13 (95% CI: 1.03-1.24), and 1.15 (95% CI: 1.05-1.27), respectively, per unit increase in pretransplantation BMI. The need for more aggressive DM treatment (suggesting a worsening of DM status) was most usually seen between discharge and 3months; 50% of patients with preexisting DM required more aggressive DM treatment post-transplantation (X3 2 = 13.25; P= 001). Conclusion: The odds of developing NODAT at discharge and 3 and 6months post-transplantation increased per unit of pretransplantation BMI. The most common time for NODAT to develop or for preexisting DM to worsen was within 3months of kidney transplantation.