Obesity Predicts New-Onset Diabetes After Live Kidney Donation.

[Clark]

http://atcmeetingabstracts.com/abstract/obesity-predicts-new-onset-diabetes-after-live-kidney-donation/

Obesity Predicts New-Onset Diabetes After Live Kidney Donation.
K. Lentine,1 A. Naik,2 N. Lam,3 M. Schnitzler,1,6 H. Xiao,1 D. Axelrod,4 G. Hess,5 B. Kasiske,6 A. Garg,7 S. Gustafson,6 D. Brennan,8 D. Segev.9,6
Meeting: 2017 American Transplant Congress
Abstract number: A254

End-stage renal disease is uncommon in living kidney donors (LKD), but recent data suggest that most kidney failure developing late after donation is due to diabetes or hypertension. To improve understanding of the relationship between obesity and post-donation diabetes mellitus (PDDM), we examined a novel linkage of national transplant registry data with records from a pharmacy claims clearinghouse that identifies diabetes treatments.
Of 20,238 LKD with at least 1 year of pre-donation pharmacy fill records, 100 with diabetes medication fills before donation were excluded. Pharmacy fills for insulin and non-insulin diabetes agents were examined as measures of new-onset PDDM. Time to first fill of insulin or other diabetes agents in relation to body mass index (BMI), age, sex, race, and other clinical factors in the registry was examined by Kaplan-Meier analysis and Cox regression (adjusted hazard ratio, LCL aHR UCL).
Mean age at donation was 42.7 years. Of LKD, 67.5% were women; 75% white, 10.5% black, and 10.9% Hispanic; 40.8% were overweight (BMI 25-<30 m2) and 22.8% were obese (BMI ≥30 kg/m2). The 5-year risk of non-insulin PDDM treatments rose in a graded manner with higher BMI, from 0.6% in normal weight to 3-fold increased risk in overweight (1.5%, aHR, 1.763.055.27) and 3.4% in obese (3.4%, aHR, 3.706.4511.03) LKDs.Adjusted 5-year risk of insulin use after donation was 5 times higher in obese than in normal weight LKDs (1.1% vs 0.04%, aHR, 1.095.2425.3). Once PDDM treatments were started, use of non-insulin agents and insulin continued over 99% and 30% of remaining observation.
Obesity is a strong correlate of PDDM treatments in LKD. Future research should define relationships of obesity and PDDM with outcomes including kidney failure after donation.
CITATION INFORMATION: Lentine K, Naik A, Lam N, Schnitzler M, Xiao H, Axelrod D, Hess G, Kasiske B, Garg A, Gustafson S, Brennan D, Segev D. Obesity Predicts New-Onset Diabetes After Live Kidney Donation. Am J Transplant. 2017;17 (suppl 3).