沙特阿拉伯一家三级中心对肾移植受者移植后糖尿病的发病率及危险因素的回顾性研究。

Incidence and risk factors of post-transplant diabetes mellitus among kidney transplant recipients: a retrospective study from a tertiary center in Saudi Arabia.

作者信息

Alotaibi Mutlaq, Almalki Najlaa, Alotaibi Manal E, Alosaimi Majed, Alazwari Monther, Hussein Mohamed, Alhomayani Faisal, Alotaibi Abdulmajeed, Bajaber Ameerah, Bhutto Fahad, Algethami Abdulmajeed, Almalki Bassem A

机构信息

Department of Nephrology and Kidney Transplantation, AlHada Armed Forces Hospital, Taif, Saudi Arabia.

Department of Medicine, College of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia.

出版信息

BMC Nephrol. 2025 Aug 13;26(1):460. doi: 10.1186/s12882-025-04375-x.

DOI:10.1186/s12882-025-04375-x

PMID:40804369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12351927/

Abstract

BACKGROUND

Post-transplant diabetes mellitus (PTDM) is a common metabolic complication following kidney transplantation, adversely affecting graft and patient outcomes. This study aims to identify the prevalence, risk factors, and clinical implications of PTDM among kidney transplant recipients at Alhada Armed Forces Hospital, Taif, Saudi Arabia.

METHODS

We conducted a retrospective cohort study including adult kidney transplant recipients from January 1984 to December 2023, excluding patients with pre-existing diabetes. Data were extracted from electronic medical records, encompassing demographics, clinical characteristics, transplantation details, and laboratory parameters. PTDM was diagnosed based on the American Diabetes Association criteria. Statistical analyses included t-tests, multivariate logistic regression, chi-square tests, Mann-Whitney U test, and Fisher’s exact tests. Receiver operating characteristic (ROC) curve analysis determined optimal cutoff values for predictive variables.

RESULTS

Of 228 kidney transplant recipients (64% males, mean age 47.2 ± 14.6 years), 54 (23.7%) developed PTDM. PTDM patients were significantly older (53.1 ± 12.9 vs. 45.4 ± 14.6 years, < 0.001) and had higher BMI (27.0 ± 4.7 vs. 25.2 ± 5.4 kg/m², = 0.023). Hypertension was a more frequent cause of ESRD in the PTDM group (24.1% vs. 6.3%, = 0.006). Tacrolimus levels ≥ 7 ng/mL were associated with higher PTDM incidence (70% vs. 52%, = 0.032). Hypomagnesemia and uACR were also higher in PTDM patients compared to non-PTDM. Multivariate logistic regression identified age, hypomagnesaemia, uACR ≥ 9, and tacrolimus levels > 7 as independent PTDM predictors ( < 0.05).

CONCLUSIONS

PTDM affects a substantial proportion of kidney transplant recipients, with older age, hypomagnesemia, increased uACR, and elevated tacrolimus levels emerging as key risk factors. Close monitoring and individualized immunosuppressive strategies may mitigate PTDM risk and improve post-transplant outcomes.

TRIAL REGISTRATION

Not applicable. The study is not a clinical trial.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12882-025-04375-x.

摘要

背景

移植后糖尿病（PTDM）是肾移植后常见的代谢并发症，对移植肾和患者预后产生不利影响。本研究旨在确定沙特阿拉伯塔伊夫市阿尔哈达武装部队医院肾移植受者中PTDM的患病率、危险因素及临床意义。

方法

我们进行了一项回顾性队列研究，纳入了1984年1月至2023年12月的成年肾移植受者，排除既往有糖尿病的患者。数据从电子病历中提取，包括人口统计学、临床特征、移植细节和实验室参数。PTDM根据美国糖尿病协会标准进行诊断。统计分析包括t检验、多因素逻辑回归、卡方检验、曼-惠特尼U检验和费舍尔精确检验。受试者工作特征（ROC）曲线分析确定预测变量的最佳截断值。

结果

在228例肾移植受者中（64%为男性，平均年龄47.2±14.6岁），54例（23.7%）发生了PTDM。PTDM患者年龄显著更大（53.1±12.9岁 vs. 45.4±14.6岁，P<0.001），BMI更高（27.0±4.7 vs. 25.2±5.4 kg/m²，P=0.023）。高血压是PTDM组中ESRD更常见的原因（24.1% vs. 6.3%，P=0.006）。他克莫司水平≥7 ng/mL与更高的PTDM发生率相关（70% vs. 52%，P=0.032）。与非PTDM患者相比，PTDM患者低镁血症和尿白蛋白肌酐比值（uACR）也更高。多因素逻辑回归确定年龄、低镁血症、uACR≥9以及他克莫司水平>7为PTDM的独立预测因素（P<0.05）。