Elsevier

Transplantation Proceedings

Volume 46, Issue 1, January–February 2014, Pages 145-150
Transplantation Proceedings

New vistas in transplantation
Renal transplantation
Hyperparathyroidism and New Onset Diabetes After Renal Transplantation

https://doi.org/10.1016/j.transproceed.2013.07.076Get rights and content

Abstract

Background

Secondary hyperparathyroidism persists after renal transplantation in a substantial number of patients. Primary hyperparathyroidism and secondary hyperparathyroidism are both associated with abnormalities in glucose metabolism, such as insufficient insulin release and glucose intolerance. The association of hyperparathyroidism and diabetes after renal transplantation has, as far as we know, not been studied. Our aim was to investigate whether hyperparathyroidism is associated with new-onset diabetes mellitus after transplantation (NODAT) during the first year posttransplantation.

Study Design

In a retrospective study, we analyzed data on patient characteristics, treatment details, and parathyroid hormone (PTH) in 245 adult nondiabetic patients who underwent renal transplantation between January 2000 and June 2011.

Results

The first year cumulative incidence of NODAT was 15%. The first serum PTH value after transplantation was above normal range in 74% of the patients. In multiple logistic regression analysis, PTH levels above twice normal range (>13.80 pmol/L) were significantly associated with NODAT (odds ratio [OR], 4.25; 95% confidence interval [CI], 1.13–15.92; P = .03) compared with PTH within normal range (≤6.9 pmol/L). Age between 45 and 65 years (OR, 2.80; 95% CI, 1.07–7.36; P = .04) compared with age <45 years was also associated with NODAT.

Conclusion

We found a strong association between hyperparathyroidism and NODAT in the first year after renal transplantation. Both conditions are common and have a negative impact on graft and patient survivals. Our results should be confirmed in prospective studies.

Section snippets

Patients

In a retrospective study, we included all adult kidney allograft recipients with follow-up visits for ≥1 year at the Department of Nephrology and Transplantation, Skåne University Hospital, Malmö and Lund, respectively, between January 2000 and June 2011. A total of 335 patients fulfilled the inclusion criteria. All patients but 1 was transplanted at our center. Altogether, 90 patients were excluded from the study because of DM at the time of transplantation (n = 75), age <18 years (n = 12), or

Results

Out of 245 patients, 36 developed NODAT, yielding a cumulative incidence of 15% during the first year posttransplantation. In 94% of cases, the diagnosis was made within 180 days after transplantation (range, 15–250). Patients with NODAT were treated with insulin (n = 19), oral diabetic agents (n = 5), dietary and exercise counseling (n = 7), or modifications in immunosuppressive therapy only (n = 4) after the diagnosis was made. Information on therapy was missing in 1 case.

Patient

Discussion

Our results show that elevated PTH levels were associated with NODAT in unadjusted regression analysis. This association persisted in the adjusted model including age, sex, and PTH. We found that PTH values above twice the upper limit of the normal range were associated with NODAT. Age was also independently associated with NODAT, in line with previous studies [19], [22].

NODAT is a common complication of renal transplantation [24] and increases the risk of graft failure [25], [26], [27] and

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