Date

September 2012

Document Type

Thesis

Degree Name

M.S.

Institution

Oregon Health & Science University

Abstract

Background: Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD). Patients who are obese at the time of kidney transplantation are considered to be at increased risk for developing new-onset diabetes mellitus after transplant (NODAT) or worsening of pre-existing diabetes mellitus (DM). This study was designed to determine if these beliefs are true. Objectives: 1. To determine the relationship between pre-transplant body mass index (BMI) and the development NODAT. 2. To determine the relationship between pre-transplant BMI and the worsening of pre-existing DM in adults after kidney transplantation. Methods: Medical records of 204 adults who underwent a first renal transplant at OHSU between August 2008 and February 2011 were reviewed. Patients who received simultaneous organ transplantation who were immunosupressed for non-transplant reasons or who were less than 18 years of age were excluded. Of the 204 patients assessed, 179 were included in the data analysis. Baseline data were collected at the time of hospital admission immediately before transplantation and included: etiology of ESRD, diagnosis of pre-existing DM, age, sex, ethnicity, weight, height, BMI, plasma creatinine concentration, estimated glomerular filtration rate (eGFR), and type of induction immunosuppression therapy. Outcome data were collected at the time of hospital discharge and 3, 6, and 12, months after kidney transplantation. Collected data included weight, BMI, DM treatment regimen if indicated, plasma creatinine concentration, eGFR, and type of maintenance immunosupression therapy. Logistic regression was used to determine the relationship between pre-transplant BMI and the development of NODAT at discharge, 3, 6, and 12 months. McNemar’s test for correlated proportions was used to assess whether a patient whose DM status worsened during one time interval was likely to continue to worsen in subsequent time intervals. Fisher’s test was used to determine if changes in DM treatment following a kidney transplant were related to changes in BMI after transplant. Results: 1. The cumulative incidence of NODAT at discharge, 3, 6, and 12 months was 14.2%, 19.4%, 20.1%, and 19.4%, respectively. 2. The odds of developing NODAT by discharge, 3, or 6 months after transplant were 1.11 (CI 1.0-1.23), 1.13 (CI 1.03-1.24), and 1.15 (CI 1.05-1.27) per unit increase in pre-transplant BMI. 3. There was a positive association between change in DM treatment from admission to discharge and change in DM treatment from discharge to three months (X32=13.25; p-value = 0.001). Conclusion: 1. The odds of developing NODAT increased per unit of pre-transplant BMI at discharge, 3 months and 6 months. 2. The development of NODAT is most likely to occur within 3 months of transplantation. 3. The most critical time period for a person with pre-existing DM to experience a worsening of their condition is within the first three months after transplantation.

Identifier

doi:10.6083/M41N7Z4Q

Division

Graduate Programs in Human Nutrition

School

School of Medicine

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.