番茄社区

BOSTON -- Patients with autosomal dominant polycystic kidney disease (ADPKD) seem more likely to develop new-onset diabetes after transplantation, researchers reported here.

Based on a meta-analysis of data from 12 separate studies, the risk ratio of new-onset diabetes after transplantation was 1.92 (95% CI 1.36-2.70), according to , of the Mayo Clinic in Rochester, Minn., and colleagues.

However, some of the included studies did not control for confounders, the authors noted in a poster presentation at the National Kidney Foundation meeting.

When those studies were excluded, the pooled RR was 1.98 (95% CI, 1.33-2.94), they reported.

The authors also pooled three studies to look at the relationship between ADPKD and risk of requiring insulin treatment new-onset diabetes after transplantation, but found that the association was not significant (RR 1.57, 95% CI 0.75-3.27).

"The findings of this study may impact clinical management and follow-up for ADPKD patients after kidney transplantation," they wrote.

They explained that evidence for the link between ADPKD and new-onset diabetes after transplantation has been conflicting, but the incidence of new-onset diabetes after transplantation in these patients is on the rise, range from 7% to 46%.

"It has been proposed that insulin resistance genes co-transmitted with polycystic kidney disease 1 and polycystic kidney disease 2 mutations may interfere with insulin secretion and hepatic gluconeogenesis," they wrote. In addition, evidence suggests that ADPKD patients with normal kidney function have increased insulin resistance.

The analysis comprised 1,379 patients with ADPKD and a total of 9,849 patients who had undergone kidney transplantation. Only studies that reported relative risks, odd ratios, or hazard ratios for the risk of new-onset diabetes after transplantation for patients with ADPKD were included. The risk ratios in the analysis were determined using a random-effect, generic inverse variance method, the authors explained.

They pointed out that other risk factors for developing diabetes after transplantation include obesity, hepatitis C virus, cytomegalovirus infection, impaired fasting glucose, and ethnicity. In addition, patients using corticosteroids or calcineurin inhibitors also have higher risks.

"I think this is a great study in a very focused population," commented , of Massachusetts General Hospital in Boston, in an interview with 番茄社区. "Yes, their kidney function may be normal after transplantation, but we know that they have a genetic pre-disposition to developing diabetes." Eneanya was not involved in the study.

In an email to 番茄社区, , at St. Clair Nephrology in Detroit, said the study was interesting, but that there was no direct clinical findings that would change management or counseling of patients with ADPKD.

"The unfortunate truth is that the majority of patients with ADPKD will ultimately progress to end-stage renal disease and require renal replacement therapy," wrote Topf, who was not involved in the study. "New-onset diabetes after transplantation is a too common complication of transplant, and telling me that a patient has a higher likelihood of developing this complication is not going to change the reality that transplant is the best treatment for renal failure."

Cheungpasitporn said study limitations included a lack of causation in the studies analyzed so it's still unknown as to the causes of new-onset diabetes after transplantation in these patients. He suggested that transplantation could have an effect on insulin, such that these patients are insulin resistant and not insulin deficient. "But that's just our postulation," he cautioned.

"Since we found a significant association, the next step is how to meaningfully address the clinical implications in the future -- how to catch early, how to prevent early, and how to reduce risk of diabetes," he said.

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