Relation between pretransplant magnesemia and the risk of new onset diabetes after transplantation within the first year of kidney transplantation.

BACKGROUND: New-onset diabetes after transplantation (NODAT) is a frequent condition associated with a poor outcome. In kidney transplantation, hypomagnesemia is a frequent posttransplant complication and has been associated with calcineurin inhibitors use. Previous studies have analyzed the relationship between posttransplant hypomagnesemia and the risk of NODAT and provided conflicting conclusions. We conducted an observational study to analyze the relationship between pretransplant magnesemia (Mg) and the risk of NODAT within the first year of kidney transplantation. METHODS: A cohort study was conducted to determine the risk conferred by pretransplant magnesium level on development of NODAT within 1 year posttransplant. First time kidney transplant recipients between January 2005 and December 2010 with more than 6 months of follow-up were included. Mg was measured within the 24 hours preceding kidney transplantation. NODAT was defined according to the American Diabetes Association criteria. RESULTS: Among the 154 patients analyzed, 28 (18.2%) developed NODAT at year 1. NODAT patients had lower levels of pretransplant Mg as compared with non-NODAT patients (P<0.02). When patients were divided into tertiles of Mg level, NODAT developed more frequently in patients in the lower tertile (Mg <2 mg/dL) as compared with patients in the higher tertile (Mg >2.3 mg/dL) (log rank, P<0.05). A multivariate analysis after adjustment to several variables demonstrated pretransplant Mg to be an independent risk factor of NODAT. CONCLUSION: This study supports that a low pretransplant Mg level is an independent risk factor of NODAT in kidney transplant recipients.

Long-term maintenance immunosuppressive regimen with tacrolimus monotherapy.

BACKGROUND: The long-term outcome of kidney transplant recipients on monotherapy with calcineurin inhibitors has been poorly analyzed. This study aimed to describe the long-term outcome of patients on Tac monotherapy (mTac) and to compare this regimen to a standard dual therapy with Tac/MMF. MATERIAL AND METHODS: This retrospective study included 84 consecutive first kidney recipients transplanted between 1998 and 2003 and followed until 2010. Patients were treated with mTac after the 6th month of transplantation. Survival and incidence of adverse events were analyzed and compared to those of patients treated with Tac/MMF as maintenance regimen after the 6th month of transplantation. RESULTS: Mean follow-up of the mTac cohort was 8.7 ± 2.2 years. Overall patient and graft survival of the mTac cohort was 91.3% and 86.6%, respectively, at year 8 posttransplant. Tac monotherapy was started in 93.3% of patients at month 6 posttransplant and maintained in 50% of the cohort at the end of the follow-up period. Incidence of acute rejection (AR) and chronic allograft nephropathy (CAN) were 11.9% and 16.6%, respectively. Kaplan-Meyer analysis did not show any difference in patient and graft survival between mTac patients and patients under Tac/MMF. At year 6, compared to Tac/MMF patients, mTac patients had a significantly lower incidence of AR after the 6th month posttransplant and no difference in CAN, cancer, NODAT, and cardiovascular events incidence. CONCLUSIONS: This work suggests that long-term maintenance immunosuppression with mTac is safe in low-immunological risk patients and should be considered for use especially in patients with MMF intolerance.

[Prospective observational study of drug-induced hyperkalemia in hospitalized non dialized adult patients]. / Etude prospective observationnelle des hyperkaliémies médicamenteuses chez des adultes non dialysés hospitalisés.

OBJECTIVE: To study the incidence and risk factors of drug-induced hyperkalemia in adult, hospitalized patients. METHODOLOGY: A three months prospective observational study was used including all hospitalized, non dialyzed, patients older than 17 years who presented with a hyperkalemia egal or over 6 mmol/L. The studied variables were demographic, clinical, biological and therapeutic. RESULTS: Forty patients, among 112 included, had a hyperkalemia promoted by drug(s) (3.5 cases for 1000 hospitalized patients). They were 73 +/- 15 years old and 72.5% had a past medical history of chronic renal failure. The hyperkalemia (6.42 +/- 0.48 mmol/L) was associated with an increase in creatininemia in 67.5% of patients. The most frequent treatment observed were renin angiotensin system drugs in 62.5% of patients, spironolactone in 37.5% or both drugs in 25%. CONCLUSION: A better use of these drugs would be able to prevent some cases of hyperkalemia.

Absence of renal lesions in C57BL/KaLwRij mice with advanced myeloma due to 5T2MM cells.

Renal failure is one of the main complications in multiple myeloma (MM) and histopathological lesions are due to light chains accumulation in the kidney. The 5T2MM mouse model closely mimics osteolytic lesions observed in clinics. We studied the occurrence of pathological changes in the kidney of mice inoculated with 5T2MM myeloma cells. No renal lesions due to light chain deposition were observed after histological, immunological staining and dosage of creatinine in serum and urine. PTH levels decreased in 5T2MM mice, confirming the absence of secondary hyperparathyroidism. Osteolytic lesions appear to be the unique consequence of 5T2MM cells inoculation.