Arabi Ziad, Alghamdi Hazim S, Arabi Tarek, Shafqat Areez, Elwy Badr, Sabbah Belal
Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Riyadh 14611, Saudi Arabia.
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Ther Adv Endocrinol Metab. 2024 Nov 30;15:20420188241301940. doi: 10.1177/20420188241301940. eCollection 2024.
There is limited data about the risk factors of clinically significant glycosylated hemoglobin (HbA1c) change and post-transplant diabetes mellitus (PTDM) in the first year post-kidney transplantation (KT), especially in the Middle East.
To determine the trends of HbA1c levels, the risk factors associated with HbA1c increases, and predictors of clinically significant HbA1c change and PTDM in the first year post-KT.
Retrospective chart review.
We included all KT recipients (KTRs) at our center from 2017 until 2020. The study focused on reviewing the patients' demographic information, cardiovascular risk factors, and HbA1c values at baseline, 6 months, and 12 months.
A total of 203 KTRs were included. The mean age of the participants was 44.7 ± 15.5 years, 59.1% were men, and 80.3% received living donors. Eighty-two (40.4%) KTRs had pre-KT diabetes. At 12 months post-KT, the total HbA1c change was 0.87 ± 1.6. In total, 130 (64.04%) KTRs demonstrated clinically significant HbA1c change, and 19 (15.7%) nondiabetics developed PTDM. Pre-KT diabetics suffered greater increases than their nondiabetic counterparts (0.8 vs 0.6, = 0.043). Increased age (adjusted odds ratio (aOR) = 1.053), weight change (aOR = 1.055), pre-KT hypertension (aOR = 3.015), and lower baseline HbA1c (aOR = 0.453) were independently associated with clinically significant HbA1c change. PTDM patients were older ( = 0.007) and had higher HbA1c levels at baseline ( = 0.033), 6 months ( = 0.002), and 1-year post-KT ( = 0.001). Gender, type of KT, dialysis, and cardiovascular risk factors were not different between PTDM and non-PTDM patients. Abnormal perfusion tests ( < 0.001) and coronary artery disease on coronary angiogram ( = 0.046) were more common in PTDM patients. Only age was independently associated with the presence of PTDM at 1-year post-KT (aOR = 1.044).
The incidence rate of PTDM in Saudi KT patients is similar to that of other populations. Several risk factors, including low baseline HbA1c and pre-KT hypertension, predict a clinically significant change in HbA1c. Patients with these risk factors may require stricter monitoring and control of HbA1c.
关于肾移植（KT）后第一年临床显著糖化血红蛋白（HbA1c）变化及移植后糖尿病（PTDM）的危险因素的数据有限，尤其是在中东地区。
确定KT后第一年HbA1c水平的变化趋势、与HbA1c升高相关的危险因素，以及临床显著HbA1c变化和PTDM的预测因素。
回顾性病历审查。
我们纳入了2017年至2020年在我们中心接受KT的所有受者（KTR）。该研究重点回顾了患者的人口统计学信息、心血管危险因素以及基线、6个月和12个月时的HbA1c值。
共纳入203名KTR。参与者的平均年龄为44.7±15.5岁，59.1%为男性，80.3%接受活体供肾。82名（40.4%）KTR术前患有糖尿病。KT后12个月时，HbA1c的总变化为0.87±1.6。总共有130名（64.04%）KTR出现了临床显著的HbA1c变化，19名（15.7%）非糖尿病患者发生了PTDM。术前糖尿病患者的HbA1c升高幅度大于非糖尿病患者（0.8对0.6，P = 0.043）。年龄增加（调整优势比[aOR]=1.053）、体重变化（aOR = 1.055）、术前高血压（aOR = 3.015）和较低的基线HbA1c（aOR = 0.453）与临床显著的HbA1c变化独立相关。PTDM患者年龄较大（P = 0.007），且在基线（P = 0.033）、6个月（P = 0.002）和KT后1年（P = 0.001）时HbA1c水平较高。PTDM患者与非PTDM患者在性别、KT类型、透析和心血管危险因素方面无差异。PTDM患者中异常灌注试验（P<0.001）和冠状动脉造影显示的冠状动脉疾病（P = 0.046）更为常见。在KT后1年，只有年龄与PTDM的发生独立相关（aOR = 1.044）。
沙特KT患者中PTDM的发病率与其他人群相似。包括低基线HbA1c和术前高血压在内的几个危险因素可预测HbA1c的临床显著变化。具有这些危险因素的患者可能需要更严格地监测和控制HbA1c。
