open access

Vol 9, No 4 (2020)
ORIGINAL ARTICLES
Published online: 2020-07-15
Get Citation

A new scoring system to predict the incidence of new onset diabetes after transplantation (NODAT)

Debmalya Sanyal, Kingshuk Bhattacharjee, Pratik Das
DOI: 10.5603/DK.2020.0024
·
Clinical Diabetology 2020;9(4):226-232.

open access

Vol 9, No 4 (2020)
ORIGINAL ARTICLES
Published online: 2020-07-15

Abstract

Background. We performed this study to develop a new scoring system to stratify different levels of risk of developing new onset diabetes after transplantation (NODAT) in patients who underwent renal transplantation. Many prognostic variables have been previously described but few efforts have been made to group them in order to enhance their individual predictive power. Material and methods. In a first phase, 100 patients were prospectively analysed to determine which factors were significantly associated with the development of NODAT. A risk score ranging from 0 to 10 points was developed using a multivariate analysis. In a second phase, such score was validated in a new sample of 100 patients. Results. BMI ≥ 23.5 kg/m2, age ≥ 38.5 years, fasting blood sugar at 1st post-operative day ≥ 159.5 mg/dL, fasting blood sugar at 5th post-operative day ≥ 122.5 mg/dL and HOMA-IR ≥ 2.5 were found as independent prognostic variables. A clear distinction was shown among categories of low, intermediate and high risk, defined according to the risk score. Conclusion. This new scoring framework is basic and simple to accomplish. It permits a generally excellent stratification of risk of developing NODAT in patients undergoing renal transplantation. They might be separated in three risk stratification cohorts, which could be of help in early identification of NODAT.

Abstract

Background. We performed this study to develop a new scoring system to stratify different levels of risk of developing new onset diabetes after transplantation (NODAT) in patients who underwent renal transplantation. Many prognostic variables have been previously described but few efforts have been made to group them in order to enhance their individual predictive power. Material and methods. In a first phase, 100 patients were prospectively analysed to determine which factors were significantly associated with the development of NODAT. A risk score ranging from 0 to 10 points was developed using a multivariate analysis. In a second phase, such score was validated in a new sample of 100 patients. Results. BMI ≥ 23.5 kg/m2, age ≥ 38.5 years, fasting blood sugar at 1st post-operative day ≥ 159.5 mg/dL, fasting blood sugar at 5th post-operative day ≥ 122.5 mg/dL and HOMA-IR ≥ 2.5 were found as independent prognostic variables. A clear distinction was shown among categories of low, intermediate and high risk, defined according to the risk score. Conclusion. This new scoring framework is basic and simple to accomplish. It permits a generally excellent stratification of risk of developing NODAT in patients undergoing renal transplantation. They might be separated in three risk stratification cohorts, which could be of help in early identification of NODAT.

Get Citation

Keywords

NODAT, risk score, India, renal transplantation

About this article
Title

A new scoring system to predict the incidence of new onset diabetes after transplantation (NODAT)

Journal

Clinical Diabetology

Issue

Vol 9, No 4 (2020)

Pages

226-232

Published online

2020-07-15

DOI

10.5603/DK.2020.0024

Bibliographic record

Clinical Diabetology 2020;9(4):226-232.

Keywords

NODAT
risk score
India
renal transplantation

Authors

Debmalya Sanyal
Kingshuk Bhattacharjee
Pratik Das

References (28)
  1. Davidson J, Wilkinson A, Dantal J, et al. New‑onset diabetes after transplantation: 2003 International consensus guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003. Transplantation. 2003; 75: SS3.
  2. Wilkinson A, Davidson J, Dotta F, et al. Guidelines for the treatment and management of new-onset diabetes after transplantation. Clin Transplant. 2005; 19(3): 291–298.
  3. Kasiske BL, Snyder JJ, Gilbertson D, et al. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003; 3(2): 178–185.
  4. Boudreaux JP, McHugh L, Canafax DM, et al. The impact of cyclosporine and combination immunosuppression on the incidence of posttransplant diabetes in renal allograft recipients. Transplantation. 1987; 44(3): 376–381.
  5. Cosio FG, Pesavento TE, Kim S, et al. Patient survival after renal transplantation: IV. Impact of post-transplant diabetes. Kidney Int. 2002; 62(4): 1440–1446.
  6. Gunnarsson R, Arner P, Lundgren G, et al. Diabetes mellitus -- a more-common-than-believed complication of renal transplantation. Transplant Proc. 1979; 11(2): 1280–1281.
  7. Gaston RS, Basadonna G, Cosio FG, et al. National Kidney Foundation Task Force on Diabetes and Transplantation. Transplantation in the diabetic patient with advanced chronic kidney disease: a task force report. Am J Kidney Dis. 2004; 44(3): 529–542.
  8. Caillard S, Eprinchard L, Perrin P, et al. Incidence and risk factors of glucose metabolism disorders in kidney transplant recipients: role of systematic screening by oral glucose tolerance test. Transplantation. 2011; 91(7): 757–764.
  9. Sulanc E, Lane JT, Puumala SE, et al. New-onset diabetes after kidney transplantation: an application of 2003 International Guidelines. Transplantation. 2005; 80(7): 945–952.
  10. Chakkera HA, Knowler WC, Devarapalli Y, et al. Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus. Clin J Am Soc Nephrol. 2010; 5(9): 1669–1675.
  11. American Diabetes Association. Classification and diagnosis of diabetes. Sec. 2. In Standards of Medical Care in Diabetes 2017. Diabetes Care. 2017; 40(Suppl. 1): S11–S24.
  12. Montori VM, Basu A, Erwin PJ, et al. Posttransplantation Diabetes: A systematic review of the literature. Diabetes Care. 2002; 25(3): 583–592.
  13. Cosio FG, Pesavento TE, Kim S, et al. Patient survival after renal transplantation: IV. Impact of post-transplant diabetes. Kidney Int. 2002; 62(4): 1440–1446.
  14. Gourishankar S, Jhangri GS, Tonelli M, et al. Development of diabetes mellitus following kidney transplantation: a Canadian experience. Am J Transplant. 2004; 4(11): 1876–1882.
  15. Kasiske BL, Snyder JJ, Gilbertson D, et al. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003; 3(2): 178–185.
  16. Boudreaux JP, McHugh L, Canafax DM, et al. The impact of cyclosporine and combination immunosuppression on the incidence of posttransplant diabetes in renal allograft recipients. Transplantation. 1987; 44(3): 376–381.
  17. Shah T, Kasravi A, Huang E, et al. Risk factors for development of new-onset diabetes mellitus after kidney transplantation. Transplantation. 2006; 82(12): 1673–1676.
  18. Marrero D, Hernandez D, Tamajón LP, et al. For the Spanish Late Allograft Dysfunction Study Group. Pre-transplant weight but not weight gain is associated with new-onset diabetes after transplantation: a multi-centre cohort Spanish study. NDT Plus. 2010; 3(Suppl_2): ii15–ii20.
  19. Midtvedt K, Hartmann A, Hjelmesaeth J, et al. Insulin resistance is a common denominator of post-transplant diabetes mellitus and impaired glucose tolerance in renal transplant recipients. Nephrol Dial Transplant. 1998; 13(2): 427–431.
  20. Bayés B, Lauzurica R, Granada ML, et al. Adiponectin and risk of new‑onset diabetes mellitus after kidney transplantation. Transplantation. 2004; 78: 26–30.
  21. Chakkera HA, Knowler WC, Devarapalli Y, et al. Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus. Clin J Am Soc Nephrol. 2010; 5(9): 1669–1675.
  22. Maldonado F, Tapia G, Ardiles L. Early hyperglycemia: a risk factor for posttransplant diabetes mellitus among renal transplant recipients. Transplant Proc. 2009; 41(6): 2664–2667.
  23. Wojtusciszyn A, Mourad G, Bringer J, et al. Continuous glucose monitoring after kidney transplantation in non-diabetic patients: early hyperglycaemia is frequent and may herald post-transplantation diabetes mellitus and graft failure. Diabetes Metab. 2013; 39(5): 404–410.
  24. Boudreaux JP, McHugh L, Canafax DM, et al. The impact of cyclosporine and combination immunosuppression on the incidence of posttransplant diabetes in renal allograft recipients. Transplantation. 1987; 44(3): 376–381.
  25. Hecking M, Haidinger M, Döller D, et al. Early basal insulin therapy decreases new-onset diabetes after renal transplantation. J Am Soc Nephrol. 2012; 23(4): 739–749.
  26. Chakkera HA, Chang YH, Ayub A, et al. Validation of a pretransplant risk score for new-onset diabetes after kidney transplantation. Diabetes Care. 2013; 36(10): 2881–2886.
  27. Cooper L, Oz N, Fishman G, et al. New onset diabetes after kidney transplantation is associated with increased mortality-A retrospective cohort study. Diabetes Metab Res Rev. 2017; 33(8).
  28. Cosio FG, Pesavento TE, Kim S, et al. Patient survival after renal transplantation: IV. Impact of post-transplant diabetes. Kidney Int. 2002; 62(4): 1440–1446.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl