Post-Kidney-Transplant Diabetes: Evaluation of Risk Factors.

INTRODUCTION: Post-transplant diabetes mellitus is a complication of kidney transplantation with deleterious effects on graft and patient survival and is associated with higher mortality. The goal of this paper is to identify risk factors that contribute to its development so that it can be avoided. METHODS: We performed a retrospective analysis of 659 kidney transplants performed in adult patients between January 2013 and December 2017. We excluded patients with a previous diagnosis of diabetes mellitus and identified 61 patients with post-transplant diabetes mellitus (10.6%), then compared them to a control group of 61 patients who did not suffer from the disease, namely the kidney transplant pair or the patient submitted for transplant immediately after. DISCUSSION: A comparative analysis of the 2 groups revealed significant differences regarding the use of ß-blockers, fasting glucose on the fifth day post-transplant, kidney recipient age, and body mass index. Using multivariate logistic regression methods, 2 variables with an impact on post-transplant diabetes development were found: fasting glucose on the fifth day post-transplant (odds ratio 1.044, 95% confidence interval 1.010-1.079, P = .010) and body mass index (odds ratio 1.130, 95% confidence interval 1.009-1.264, P = .034). We did not find any differences for other potential risk factors. CONCLUSION: A high plasma glucose level on the fifth day after the transplant and a high body mass index in the setting of the transplant can potentially impact the transplant's outcomes, so it is important to identify these levels as soon as possible to take measures to prevent this disease.

Kidney transplantation: which variables should be improved?

INTRODUCTION: Several factors have an impact on allograft survival but many are still controversial. In this study we investigated the effect of multiple factors on early renal graft function as an effort to find new tools to improve. MATERIAL AND METHODS: This was a transversal study of 64 patients who underwent kidney transplantation during the first semester of 2013. Demographic, clinical, and laboratory data were collected and analyzed. We used SPSS 20.0. Univariate analysis through nonparametric tests and multivariate analysis through linear regression were made. RESULTS: Regarding the donor, age (ß = 1.581; P = .003) and stroke as cause of death (P = .044) were associated with a higher creatinine level. Concerning the recipient, age (ß = 0.963; P = .001) as well as the difference between the candidate and the donor (ß = 1.203; P = .000), black race (P = .032/.000), male gender (P = .027/.046), vasculopathic end-stage renal disease (ESRD; P = .050), hemodialysis (HD) modality (P = .001/.033), HD session before surgery (P = .005), body mass index (BMI) >25 kg/m(2) (P = .043), hypoalbuminemia (ß = -0.280/-0.076; P = .029/.046), and anemia (ß = -0.361; P = .032) were also associated with a higher creatinine level. Living donor transplant (P = .000/.043), instant diuresis (P = .000/.021), and post-transplantation higher blood pressure (BP; systolic BP [SBP] ß = -0.452; P = .021 and diastolic BP [DBP] ß = -0.318; P = .033) were associate with lower creatinine values. Overall, 87.6% of the renal function markers after the first semester were explained by the multiple factors above mentioned. CONCLUSIONS: Our findings are of practical clinical interest because nutritional status, hemoglobin, albumin, and BP are some of the objective measurable and modifiable parameters of which management may improve renal graft function.