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Journal : Indonesian Journal of Kidney and Hypertension

Effect of Calcineurin Inhibitor on Blood Glucose Level in Non-Diabetic Kidney Transplant Patients Aditiawardana, A; Liani, Fauzia N; Irwanadi, Chandra; Mardiana, Nunuk; Pranawa, P
Indonesian Journal of Kidney and Hypertension Vol 1 No 1 (2018): September - December 2018
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (494.625 KB) | DOI: 10.32867/inakidney.v1i1.7

Abstract

Background Calcineurin inhibitor (CNI) is a class of immunosuppressant agent used in kidney transplant management, known to pose risk for new-onset diabe­tes after transplant (NODAT). Tacrolimus and cyclo­sporine cause NODAT through multiple mechanisms, such as decreasing insulin secretion, increasing in­sulin resistance, and a direct effect on the pancreatic beta cell. Method This is a retrospective study on pa­tients receiving immunosuppressant agents for kidney transplant patients in Surabaya. The immunosuppres­sant agents studied were CNI (tacrolimus and cyclo­sporine) in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroid. The blood glucose measured were fasting blood glucose (FBD) and 2-hour postprandial blood glucose (2PPBG). Ob­jective Aim of this study is to determine the effect of calcineurin inhibitor (CNI) on glucose regulation in the nondiabetic renal transplant patient. Result Fifty-six subjects were included in the study, divided into two groups. One group of 28 patients (50%) received tac­rolimus-MMF-MP and the other group received cyc­losporine-MMF-MP. A significant increase in fasting blood glucose (pre-intervention level 86 ± 6 mg/dl vs post-intervention level 109 ± 34 mg/dl with p = 0.01) and 2-hour postprandial blood glucose (pre-interven­tion level 117 ± 20 mg/dl vs post-intervention level 150 ± 43 mg/dl with p < 0.001) was found in the tacro­limus group. A significant increase was also found in the cyclosporine group, both in fasting blood glucose (pre-intervention value 85 ± 7 mg/dl vs post-interven­tion value 97 ± 22 mg/dl with p = 0.002) and 2-hour postprandial blood glucose (pre-intervention value 119 ± 18 mg/dl vs post-intervention value 148 ± 55 mg/dl with p = 0.001). Tacrolimus was found to have a relative risk of NODAT up to 1.2 fold compared to cy­closporine. Conclusion Tacrolimus poses 1.29 relative risk of NODAT compared to cyclosporine. However, both drugs significantly increase fasting blood glucose and 2-hour postprandial blood glucose in non-diabetic patients receiving kidney transplantation.
Risk Factors for New-Onset Diabetes After Transpant in Kidney Transplant Recipients Pramudya, Dana; Aditiawardana, Aditiawardana; Tjempakasari, Artaria; Irwanadi, Chandra; Mardiana, Nunuk; Pranawa, Pranawa; Widodo, Widodo
Indonesian Journal of Kidney and Hypertension Vol 2 No 1 (2019): January - April 2019
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (443.476 KB)

Abstract

Background New-onset diabetes after transplant (NODAT) is one of the metabolic complications of kidney transplant surgery. The incident of NODAT varies highly, from 5% up to 53%. Some factors increase the risk for NODAT, such as age, gender, immunosuppressant drugs, among others. The progressivity of NODAT leads to increased cardiovascular risks, making the identification of risk factors crucial. Method Medical records of 56 patients who have undergone kidney transplant throughout 1998 - 2015 were evaluated. Data obtained from the records include age, gender, history of hypertension, dyslipidemia, the use of calcineurin inhibitors (CNI), and familial history of diabetes. Bivariate analysis with crosstabs (for nominal data) was used to analyze the data, with a threshold of p < 0.25 and followed up with multivariate analysis using logistic regression. Result The mean age of subjects was 53.85±12.92 years, with 80.4% of the subjects were male. Pre-transplant hypertension was 46.4%. The CNI used were tacrolimus in 46.4% and cyclosporine in 53.6% of patients. Around 25% of patients have a familial history of diabetes and the mean triglyceride level was 165.83±77.5 mg/dl. NODAT occurred in 18 patients and the majority of occurrence happened in the first year post-transplant. Bivariate analysis shows no significant risk factors, however clinically significant risk factors were gender (male), the CNI drug used (tacrolimus), and familial history of diabetes. Further multivariate analysis showed OR for gender (male) with OR 6.532 (0.735- 58.051), age with OR 5.249 (0.658-41.853)}, and the use of tacrolimus with OR 3.217 (0.895-11.571). Conclusion In this study, the clinically significant risk factors for NODAT were male gender, age, and the use of tacrolimus. However, these risk factors did not show statistical significance. Further study with bigger sample size is needed.