Kidney Week

Abstract: SA-OR077

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

Session Information

• Transplant Economics and Live Donor Outcomes
  November 04, 2017 | Location: Room 390, Morial Convention Center
  Abstract Time: 05:42 PM - 05:54 PM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine, MD, PhD, FASN



• Koraishy, Farrukh M., Saint Louis University, St. Louis, Missouri, United States

Farrukh M. Koraishy,

• Naik, Abhijit S., None, Ann Arbor, Michigan, United States

Abhijit S. Naik,

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Axelrod, David A, Lahey Hospital and Clinic, Burlington, Massachusetts, United States

David A Axelrod,

• Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States

Mark Schnitzler,

• Zhang, Zidong, Saint Louis University, St. Louis, Missouri, United States

Zidong Zhang,

• Hess, Gregory P., LDI University of Pennsylvania/IMS, Plymouth Meeting, Pennsylvania, United States

Gregory P. Hess,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States

Bertram L. Kasiske,

• Brennan, Daniel C., Washington University in St. Louis, St. Louis, Missouri, United States

Daniel C. Brennan,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

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, _1.763.05_5.27) and 3.4% in obese (3.4%, aHR, _3.706.45_11.03) 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, _1.095.24_25.3). [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