Abstract: SA-OR077

Obesity Is a Risk Factor for New-Onset Diabetes Mellitus after Living Kidney Donation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States
  • Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States
  • Brennan, Daniel C., Washington University in St. Louis, St. Louis, Missouri, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • Koraishy, Farrukh M., Saint Louis University, St. Louis, Missouri, United States
  • Naik, Abhijit S., None, Ann Arbor, Michigan, United States
  • Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada
  • Axelrod, David A, Lahey Hospital and Clinic, Burlington, Massachusetts, United States
  • Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States
  • Zhang, Zidong, Saint Louis University, St. Louis, Missouri, United States
  • Hess, Gregory P., LDI University of Pennsylvania/IMS, Plymouth Meeting, Pennsylvania, United States
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
Background

End-stage renal disease is uncommon in living kidney donors (LKD), but most kidney failure developing late after donation appears to be due to diabetes or hypertension. To improve understanding of the relationship of 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.

Methods

Among 20,238 LKD with at least 1 year of pre-donation pharmacy records, 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).

Results

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). [Fig1]. Once PDDM treatments were started, use of non-insulin agents and insulin continued over 99% and 30% of remaining observation.

Conclusion

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.

Funding

  • NIDDK Support