Prevalência e fatores de risco para diabetes mellitus pós-transplante renal

• Ano de defesa: 2019
• Autor(a) principal: Lucena, Debora Dias De [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Diabetes Mellitus Post Transplantation; Kidney Transplantation; Insulin Resistance.; Diabetes Mellitus Pós-Transplante; Transplante Renal; Resistência Insulínica
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=8133279; https://repositorio.unifesp.br/handle/11600/60055

Introduction: Post-transplant diabetes mellitus (DMPT) has been an important complication of kidney transplantation and has been associated with increased medical costs and death. Risk factors may be related to glucose metabolism or patient demographic characteristics, and these variables may be modifiable and nonmodifiable. Aim: To verify the prevalence of DMPT, as well as its risk factors, within three years after renal transplantation. Methodology: Modifiable and non-modifiable variables were evaluated and tested for the risk of DMPT in 450 patients undergoing renal transplantation and followed up for three years. Fisher's exact test and analysis of variances with Tukey tests for multiple comparison were performed for continuous or numerical variables and Pearson's chi-square test was used for categorical or nominal variables, P <0.05 was considered statistically significant. The immunosuppressive regimen was mainly based on tacrolimus (85%), prednisone (100%) and mycophenolate (53%). Azathioprine and imTOR were used in 41% and 10.2% of recipients, respectively. Results: In the study population, 60% were male, 47.2% were black, and 57.8% received deceased donor kidney. Sixty-one (13.5%) of the 450 recipients developed DMPT. The risk factors identified were: age of the recipient (46.2 ± 1.3 vs 40.7 ± 0.6, P = 0.001), pretransplantation dysglycemia (32.8% vs 21.6%, P = 0.032), BMI ≥ 25 kg / m2 (57.4% vs 27.7%, P <0.0001), as well as transient hyperglycemia (P = 0.0001), acute rejection (P = 0.021), inhibitor use (P = 0.014), Tg / HDL ratio ≥ 3.5 (P = 0.0001) and serum FK at months 1, 3 and 6 (P = 0.0001). Conclusion: There was a significant prevalence of DMPT, with a higher incidence in the first six months after renal transplantation, even when higher serum levels of FK were detected. It was also observed the importance of early identification of risk factors associated with increased insulin resistance, such as overweight, obesity, pretransplantation hyperglycemia, transient hyperglycemia, FK level and TG / HDL ratio, since they may be useful for risk stratification of patients to determine the appropriate strategies, in order to reduce or avoid the occurrence of DMPT.