Research ArticleSerum hs-CRP measured prior transplantation predicts of new-onset diabetes after transplantation in renal transplant recipients
Introduction
New-onset diabetes after transplantation (NODAT) is a common manifestation of kidney post-transplantation patients. We diagnosed NODAT based on blood glucose or HbA1c following to the criteria of the American Diabetes Association for both diabetes mellitus and impaired glucose tolerance [1,2]. The NODAT accounted for about 7% -30% of patients within the first year after kidney transplantation [[3], [4], [5]]. This is one of the most serious comorbidities in kidney transplant patients. It is implicated in a number of poor prognostic factors such as delayed graft function, increased cardiovascular complications and mortality rates [6,7]. Increased insulin resistance and impaired insulin production may contribute to the emergence and progression of NODAT [8]. Both traditional type 2 diabetes mellitus and transplant-related risk factors affect this condition [9]. The NODAT risk factors can be categorized into three groups: Non-modifiable, modifiable, and potentially modifiable [[10], [11], [12], [13]]. In the late 2000s, the relation among CRP levels which should reflect (latent) inflammation, atherosclerosis, diabetes and patient outcome were actively investigated and reported in renal transplant recipients [[14], [15], [16]].
Viet Nam has successfully implemented a kidney transplant since 1992, so far, more than 4000 patients with end-stage chronic kidney transplants have received a kidney transplant for more than 25 years. However, there are not many studies on the incidence and factors related to NODAT in the Vietnamese population. Therefore, we conducted this study to evaluate the incidence of NODAT for the first year post-transplantation and the predictive value of hs-CRP before transplantation for NODAT prediction.
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Subjects
We included 325 living-donor kidney transplantation patients at the Department of Nephrology and Hemodialysis, Military Hospital 103, Ha Noi, Viet Nam, into our study from January 2018 to December 2019. We excluded patients below 18 years old; those had a history of diabetes or a family member has diabetes; and those who had used immune-biological drugs pre-transplantation or had a graft rejection post-transplantation. Fasting oral glucose tolerance had done for all patients before kidney
Results
As the results in Table 1, we found no difference in sex, etiology of chronic kidney disease, the proportion of hepatitis virus infection, serum albumin level, hemoglobin level, anemia, lipid disorder, ischemic heart disease, positive PRA as well as Prednisone dose after transplant in NODAT patients and non-NODAT ones, p > 0.05.
The results in Table 1 also showed that the average age, BMI, serum hs-CRP, and arteriosclerosis rate was significantly higher in NODAT group compared to non-NODAT group
NODAT in patients after kidney transplantation
NODAT is one of the most serious complication in kidney transplanted patients. The presence of NODAT is a poor prognosis for the patients as well as for the grafts. In our study, the proportion of NODAT accounted for 12.4% among kidney recipients within the first year after transplantation (Table 1). The prevalence of NODAT in patients after kidney transplantation was different in various studies [[19], [20], [21], [22], [23]]. Bayes B. et al. [19] announced ratio of NODAT was 22.6% (45/199
Conclusion
In conclusion, ratio of NODAT for the first year in kidney transplant recipients was 12.4%. In NODAT patients, age, BMI, the proportion of arteriosclerosis, and serum hs-CRP level were significantly higher than those of non-NODAT group, p < 0.05. Serum hs-CRP concentration was a good predictor of NODAT for the first year in kidney transplant recipients.
Ethics approval and consent to participate
This study was approved by the Ethical Committee of Viet Nam Military Medical University (No: 2884/QĐ-HVQY).
Human and animal rights
Animals did not participate in this research. All human research procedures were following the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2008.
Consent for publication
Informed consent was obtained from all participants.
Declaration of Competing Interest
The authors declare no conflict of interest, financial or otherwise.
Acknowledgment
In this study, we had been strongly supported by clinical application funding of our local hospital and university to complete our research.
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