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Kidney Week

Abstract: FR-PO667

Homeostatic Model Assessment (HOMA) in Pediatric Patients with Nephrotic Syndrome Receiving Tacrolimus

Session Information

  • Pediatric Nephrology - II
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Govindan, Sukanya, Mehta Multispeciality Hospitals India Pvt Ltd, Chennai, Tamil Nadu, India
  • Singaram, Saravana Kumar, Mehta Multispeciality Hospitals India Pvt Ltd, Chennai, Tamil Nadu, India
Background

Children with nephrotic syndrome receive diabetogenic drugs like tacrolimus (TAC) and steroids. TAC is toxic to pancreatic β-cells and suppresses insulin production in a time and dose dependent manner. Post transplant diabetes mellitus due to TAC and or steroids is well documented in renal transplant patients. Although overt diabetes is rare in children receiving TAC with or without steroids for nephrotic syndrome (NS), the subclinical effect on β cell function has not been studied.

Methods

We prospectively followed children with NS who received TAC therapy at least for 1 year. We noted patient demographics, clinical and histologic pattern of NS, cumulative steroid dose (mg/kg/day) received 90 days prior and TAC C0 levels. Fasting insulin, blood sugar to calculate HOMA indices for IR (insulin resistance), HOMA % β for beta cell function, HOMA-IS (insulin sensitivity), C-peptide and HbA1C were done once at study inclusion and yearly intervals when required. Statistical analysis included Pearson’s correlation, paired t test and regression analysis.

Results

We performed HOMA indices in 37 patients between September 2021-February 2023. Six patients had 2 measurements during the study period. The mean TAC duration, TAC Co level and mean cumulative steroid dose were 27 months (95% CI[22;32]), 4.54 ng/ml (95% CI[4.12;4.97]) and 0.36 mg/kg/d (95% CI[0.28;0.44]) respectively. In Pearson's correlation analysis we found positive correlation between TAC Co level, HOMA IR (r=0.4, P=0.008) and TAC Co, HOMA %β (r=0.44, P=0.003) and cumulative steroid dose, fasting blood glucose (r=0.3, P=0.46). There was negative correlation between TAC Co level, HOMA IS (r =-0.4, P=0.007). In regression analysis, only TAC Co level significantly influenced all HOMA indices including insulin resistance, insulin sensitivity and beta cell function. A HbA1C of > 5.7 (pre-diabetes range) was found in 32.4% (12/37 )patients which warrants further monitoring. C-peptide levels were significantly higher after 12 months of TAC therapy in 6 patients who had two measurements (p=0.032).

Conclusion

Tacrolimus therapy for nephrotic syndrome in children can affect pancreatic beta cell function as assessed by HOMA indices.