Pub Date : 2019-04-01DOI: 10.32867/INAKIDNEY.V2I1.25
D. Pramudya, Aditiawardana Aditiawardana, Artaria Tjempakasari, Chandra Irwanadi, N. Mardiana, Pranawa Pranawa, W. Widodo
Background New-onset diabetes after transplant (NODAT) is one of the metabolic complications of kidney transplant surgery. The incident of NODAT varies highly, from 5% up to 53%. Some factors increase the risk for NODAT, such as age, gender, immunosuppressant drugs, among others. The progressivity of NODAT leads to increased cardiovascular risks, making the identification of risk factors crucial. Method Medical records of 56 patients who have undergone kidney transplant throughout 1998 - 2015 were evaluated. Data obtained from the records include age, gender, history of hypertension, dyslipidemia, the use of calcineurin inhibitors (CNI), and familial history of diabetes. Bivariate analysis with crosstabs (for nominal data) was used to analyze the data, with a threshold of p < 0.25 and followed up with multivariate analysis using logistic regression. Result The mean age of subjects was 53.85±12.92 years, with 80.4% of the subjects were male. Pre-transplant hypertension was 46.4%. The CNI used were tacrolimus in 46.4% and cyclosporine in 53.6% of patients. Around 25% of patients have a familial history of diabetes and the mean triglyceride level was 165.83±77.5 mg/dl. NODAT occurred in 18 patients and the majority of occurrence happened in the first year post-transplant. Bivariate analysis shows no significant risk factors, however clinically significant risk factors were gender (male), the CNI drug used (tacrolimus), and familial history of diabetes. Further multivariate analysis showed OR for gender (male) with OR 6.532 (0.735- 58.051), age with OR 5.249 (0.658-41.853)}, and the use of tacrolimus with OR 3.217 (0.895-11.571). Conclusion In this study, the clinically significant risk factors for NODAT were male gender, age, and the use of tacrolimus. However, these risk factors did not show statistical significance. Further study with bigger sample size is needed.
{"title":"Risk Factors for New-Onset Diabetes After Transpant in Kidney Transplant Recipients","authors":"D. Pramudya, Aditiawardana Aditiawardana, Artaria Tjempakasari, Chandra Irwanadi, N. Mardiana, Pranawa Pranawa, W. Widodo","doi":"10.32867/INAKIDNEY.V2I1.25","DOIUrl":"https://doi.org/10.32867/INAKIDNEY.V2I1.25","url":null,"abstract":"Background New-onset diabetes after transplant (NODAT) is one of the metabolic complications of kidney transplant surgery. The incident of NODAT varies highly, from 5% up to 53%. Some factors increase the risk for NODAT, such as age, gender, immunosuppressant drugs, among others. The progressivity of NODAT leads to increased cardiovascular risks, making the identification of risk factors crucial. \u0000Method Medical records of 56 patients who have undergone kidney transplant throughout 1998 - 2015 were evaluated. Data obtained from the records include age, gender, history of hypertension, dyslipidemia, the use of calcineurin inhibitors (CNI), and familial history of diabetes. Bivariate analysis with crosstabs (for nominal data) was used to analyze the data, with a threshold of p < 0.25 and followed up with multivariate analysis using logistic regression. \u0000Result The mean age of subjects was 53.85±12.92 years, with 80.4% of the subjects were male. Pre-transplant hypertension was 46.4%. The CNI used were tacrolimus in 46.4% and cyclosporine in 53.6% of patients. Around 25% of patients have a familial history of diabetes and the mean triglyceride level was 165.83±77.5 mg/dl. NODAT occurred in 18 patients and the majority of occurrence happened in the first year post-transplant. Bivariate analysis shows no significant risk factors, however clinically significant risk factors were gender (male), the CNI drug used (tacrolimus), and familial history of diabetes. Further multivariate analysis showed OR for gender (male) with OR 6.532 (0.735- 58.051), age with OR 5.249 (0.658-41.853)}, and the use of tacrolimus with OR 3.217 (0.895-11.571). \u0000Conclusion In this study, the clinically significant risk factors for NODAT were male gender, age, and the use of tacrolimus. However, these risk factors did not show statistical significance. Further study with bigger sample size is needed.","PeriodicalId":423107,"journal":{"name":"Indonesian Journal of Kidney and Hypertension","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127536396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-18DOI: 10.32867/INAKIDNEY.V1I1.8
Metalia Puspitasari, H. Prasanto, I. Kuswadi
Background Peritonitis has been reported to be associated with high mortality. However, information on the impact of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. ObjectiveTo determine the association between peritoneal dialysis-related early peritonitis and mortality. To determine prognostic factors on mortality in peritonitis patients with peritoneal dialysis. Methods A retrospective observational cohort study was conducted over 5 years at a single PD unit in Sardjito Hospital. Inclusion criteria: First onset of peritonitis patients with peritoneal dialysis from 2013 -2017, age ≥ 18 years old. Exclusion criteria: Incomplete medical records. A total of 48 patients on CAPD with peritonitis was divided into the early onset of peritonitis (< 20 months) and late onset of peritonitis ( ≥ 20 months. Kaplan-Meier survival curve was used to display cumulative relative risk as a parameter of prognostic factors. Results A total of 48 patients (early onset of peritonitis, n = 31; late onset of peritonitis, n = 17) were analyzed in our study with a mean of age50.6 years consisted of males 64.6%. There was a significant difference in patients’ mortality between the early and late onset of peritonitis. The Kaplan-Meier analysis revealed that log-rank test, p<0.05 with a mean survival time of patients with early peritonitis and late peritonitis was 236 days (95% CI: 162-309 days) and 1702 days (95% CI: 1067-2338 days) consecutively. Compared to those who were normoweight, underweight or overweight patients had increased risk of mortality, (RR 1.14 and 1.15; p=0.003, respectively). There was a significant association between diabetes mellitus and lower serum creatinine levels, and the risk of mortality (RR 1.43, p=0.03 and mean difference -6.01, p< 0.001, respectively). Conclusions Early peritonitis patients have a poor prognosis compared to the late peritonitis group. Patients with shorter time to first peritonitis were prone to having a higher mortality rate. Diabetes mellitus, underweight or overweight, and lower serum creatinine are prognostic factors of mortality in peritonitis patients.
{"title":"Prognostic factors and impact of peritoneal dialysis-related early peritonitis on mortality in Sardjito General Hospital, Yogyakarta, Indonesia","authors":"Metalia Puspitasari, H. Prasanto, I. Kuswadi","doi":"10.32867/INAKIDNEY.V1I1.8","DOIUrl":"https://doi.org/10.32867/INAKIDNEY.V1I1.8","url":null,"abstract":"Background Peritonitis has been reported to be associated with high mortality. However, information on the impact of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. ObjectiveTo determine the association between peritoneal dialysis-related early peritonitis and mortality. To determine prognostic factors on mortality in peritonitis patients with peritoneal dialysis. Methods A retrospective observational cohort study was conducted over 5 years at a single PD unit in Sardjito Hospital. Inclusion criteria: First onset of peritonitis patients with peritoneal dialysis from 2013 -2017, age ≥ 18 years old. Exclusion criteria: Incomplete medical records. A total of 48 patients on CAPD with peritonitis was divided into the early onset of peritonitis (< 20 months) and late onset of peritonitis ( ≥ 20 months. Kaplan-Meier survival curve was used to display cumulative relative risk as a parameter of prognostic factors. Results A total of 48 patients (early onset of peritonitis, n = 31; late onset of peritonitis, n = 17) were analyzed in our study with a mean of age50.6 years consisted of males 64.6%. There was a significant difference in patients’ mortality between the early and late onset of peritonitis. The Kaplan-Meier analysis revealed that log-rank test, p<0.05 with a mean survival time of patients with early peritonitis and late peritonitis was 236 days (95% CI: 162-309 days) and 1702 days (95% CI: 1067-2338 days) consecutively. Compared to those who were normoweight, underweight or overweight patients had increased risk of mortality, (RR 1.14 and 1.15; p=0.003, respectively). There was a significant association between diabetes mellitus and lower serum creatinine levels, and the risk of mortality (RR 1.43, p=0.03 and mean difference -6.01, p< 0.001, respectively). Conclusions Early peritonitis patients have a poor prognosis compared to the late peritonitis group. Patients with shorter time to first peritonitis were prone to having a higher mortality rate. Diabetes mellitus, underweight or overweight, and lower serum creatinine are prognostic factors of mortality in peritonitis patients.","PeriodicalId":423107,"journal":{"name":"Indonesian Journal of Kidney and Hypertension","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130839745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-18DOI: 10.32867/INAKIDNEY.V1I1.3
L. Pura, R. Bandiara, R. S. Gondodiputro
Sclerostin is a glycoprotein expressed by osteocytes and plays a role in bone turnover in themetabolism of the bone. Sclerostin blocks the formation of a ligand with its receptor on theWnt/β-catenin pathway, and influences the activity of osteoblasts. Sclerostin also influencesmineral and bone disturbances in CKD via the interaction between kidney, bone and vascularaxis. The concentration of sclerostin will rise especially in patients with ESRD undergoingdialysis. Concentration of sclerostin has not been reported yet in non-dialysis CKD patientstage 3-5 and the aim of this study is to see sclerostin concentration on those population. Methods This is a descriptive and cross-sectional study designed to measure sclerostinconcentration in non dialysis patients with CKD stage 3-5. The sclerostin concentration ismeasured using an enzyme-linked immunosorbent assay kit. CKD stages are diagnosed usingthe KDIGO-2012 criteria which measures the estimated GFR (eGFR) with the formulation of EPICKD. Fifty six patients with CKD stage 3-5 were enrolled in this study and one way ANOVA comparative test followed with a post hoc analysis using Benferroni test to analysethe data. Results The mean concentration level of serum sclerostin in this population is (79.7+ 41.2) pmol/L, and in patients with CKD stage 3, CKD stage 4, and CKD stage 5 are (59.6 +28.5) pmol/L, (71.9 + 42.2) pmol/L and (96.7 + 39.8) pmol/L respectively. The comparativetest of mean concentrations of the serum sclerostin between stages of CKD are statisticallysignificant with a p=0.022. The post hoc analysis of serum sclerostin concentration betweenCKD stage 3 and CKD stage 5 have a significant difference with a mean of 37 pmol/L andp=0.037. Conclusion, The serum sclerostin concentration rise in accordance with the declineof kidney function in patients with pre-dialysis CKD stage 3-5.
{"title":"Sclerostin Serum Concentration in Patients with Predialysis Ckd Stage 3-5","authors":"L. Pura, R. Bandiara, R. S. Gondodiputro","doi":"10.32867/INAKIDNEY.V1I1.3","DOIUrl":"https://doi.org/10.32867/INAKIDNEY.V1I1.3","url":null,"abstract":"Sclerostin is a glycoprotein expressed by osteocytes and plays a role in bone turnover in themetabolism of the bone. Sclerostin blocks the formation of a ligand with its receptor on theWnt/β-catenin pathway, and influences the activity of osteoblasts. Sclerostin also influencesmineral and bone disturbances in CKD via the interaction between kidney, bone and vascularaxis. The concentration of sclerostin will rise especially in patients with ESRD undergoingdialysis. Concentration of sclerostin has not been reported yet in non-dialysis CKD patientstage 3-5 and the aim of this study is to see sclerostin concentration on those population. Methods This is a descriptive and cross-sectional study designed to measure sclerostinconcentration in non dialysis patients with CKD stage 3-5. The sclerostin concentration ismeasured using an enzyme-linked immunosorbent assay kit. CKD stages are diagnosed usingthe KDIGO-2012 criteria which measures the estimated GFR (eGFR) with the formulation of EPICKD. Fifty six patients with CKD stage 3-5 were enrolled in this study and one way ANOVA comparative test followed with a post hoc analysis using Benferroni test to analysethe data. Results The mean concentration level of serum sclerostin in this population is (79.7+ 41.2) pmol/L, and in patients with CKD stage 3, CKD stage 4, and CKD stage 5 are (59.6 +28.5) pmol/L, (71.9 + 42.2) pmol/L and (96.7 + 39.8) pmol/L respectively. The comparativetest of mean concentrations of the serum sclerostin between stages of CKD are statisticallysignificant with a p=0.022. The post hoc analysis of serum sclerostin concentration betweenCKD stage 3 and CKD stage 5 have a significant difference with a mean of 37 pmol/L andp=0.037. Conclusion, The serum sclerostin concentration rise in accordance with the declineof kidney function in patients with pre-dialysis CKD stage 3-5.","PeriodicalId":423107,"journal":{"name":"Indonesian Journal of Kidney and Hypertension","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116491907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-18DOI: 10.32867/INAKIDNEY.V1I1.5
A. Yonata, I. Effendi, Z. Ali, N. Suhaimi, S. Suprapti
Kidney disease affects 800 million children and adults worldwide, and the numbers keep increasing. A better understanding of the pathogenesis in kidney diseases, especially on a biomolecular level, is much needed to identify novel biomarkers and therapeutic targets for kidney diseases. The glomerular filtration barrier comprises endothelial cells, the glomerular basement membrane, and podocytes. The podocyte has a central role in part of the glomerular filtration barrier. The normal functioning of podocytes is particularly important in preventing the heavy proteinuria seen in nephrotic syndrome or diabetic nephropathy, or in the disease process of focal segmental glomerulosclerosis. The podocyte is injured by circulating factors, which finally results in deranged podocyte motility. Soluble urokinase-type plasminogen activator receptor (suPAR) is a circulating form of glycosyl-phosphatidylinositol uPAR domain membrane protein and is known to play a role in the pathogenesis in kidney diseases, specifically focal segmental glomerulosclerosis and diabetic nephropathy. suPAR binds to αvβ3 integrin on podocyte foot processes and causes podocyte structure disorganization leading to glomerular filtration disruption and hence proteinuria. suPAR is also a potential biomarker to predict the incidence of CKD.
{"title":"The role of soluble urokinase-type Plasminogen Activator Receptor (suPAR) in Chronic Kidney Disease","authors":"A. Yonata, I. Effendi, Z. Ali, N. Suhaimi, S. Suprapti","doi":"10.32867/INAKIDNEY.V1I1.5","DOIUrl":"https://doi.org/10.32867/INAKIDNEY.V1I1.5","url":null,"abstract":"Kidney disease affects 800 million children and adults worldwide, and the numbers keep increasing. A better understanding of the pathogenesis in kidney diseases, especially on a biomolecular level, is much needed to identify novel biomarkers and therapeutic targets for kidney diseases. The glomerular filtration barrier comprises endothelial cells, the glomerular basement membrane, and podocytes. The podocyte has a central role in part of the glomerular filtration barrier. The normal functioning of podocytes is particularly important in preventing the heavy proteinuria seen in nephrotic syndrome or diabetic nephropathy, or in the disease process of focal segmental glomerulosclerosis. The podocyte is injured by circulating factors, which finally results in deranged podocyte motility. Soluble urokinase-type plasminogen activator receptor (suPAR) is a circulating form of glycosyl-phosphatidylinositol uPAR domain membrane protein and is known to play a role in the pathogenesis in kidney diseases, specifically focal segmental glomerulosclerosis and diabetic nephropathy. suPAR binds to αvβ3 integrin on podocyte foot processes and causes podocyte structure disorganization leading to glomerular filtration disruption and hence proteinuria. suPAR is also a potential biomarker to predict the incidence of CKD.","PeriodicalId":423107,"journal":{"name":"Indonesian Journal of Kidney and Hypertension","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126214452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-18DOI: 10.32867/INAKIDNEY.V1I1.4
D. Tanod, Linda Rotty, S. Palar, E. Moeis
Background CKD Patients on routine hemodialysis (HD) are prone to medical complications and conditions that are potentially detrimental to the quality of life (QoL), such as anemia, malnutrition, low body mass index (BMI), HD shift time, and HD adequacy measured by Kt/V. CKD patients undergoing routine HD mostly have lowered QoL and are at higher risk for malnutrition, inflammation, hospitalization, and mortality, compared to the general population. This study intends to find out whether there is a correlation between these factors and the quality of life of patients undergoing routine hemodialysis. Methods The design of this study is a cross-sectional analysis of observational data. Hemodialysis patients from general hospital Prof. dr. R. D. Kandou Manado for 3 months from August to October 2017 were included. Fifty-two patients meet the inclusion and exclusion criteria. The correlation between quality of life with anemia, serum albumin, BMI, adequacy of HD, using Pearson correlation test (if normality test fulfilled) or Spearman correlation test (if the normality test not fulfilled) and Independent Samples T-test to assess the quality of life with HD shift time. Results This study found no correlation between hemoglobin levels (p=0.244, r=-0.098), BMI (p=0.473, r=-0.010), HD timing (p=0.082) and quality of life of the patients, but a significant correlation between serum albumin (p=0.020, r=0.286), HD adequacy measured by Kt/V (p=0.030, r=0.257) and subjects’ quality of life. Conclusion This study showed that serum albumin and Kt/V values had a significant correlation with quality of life, while hemoglobin, BMI and dialysis shift time are not related to the quality of life.
背景:接受常规血液透析(HD)的CKD患者容易出现医疗并发症和对生活质量(QoL)有潜在危害的情况，如贫血、营养不良、低体重指数(BMI)、HD移位时间和以Kt/V测量的HD充分性。与普通人群相比，接受常规HD治疗的CKD患者大多生活质量较低，营养不良、炎症、住院和死亡的风险较高。本研究旨在探讨这些因素与常规血液透析患者的生活质量之间是否存在相关性。方法本研究的设计是对观测资料进行横断面分析。纳入综合医院dr. R. D. Kandou Manado教授2017年8月至10月3个月的血液透析患者。52例患者符合纳入和排除标准。生活质量与贫血、血清白蛋白、BMI、HD充分性之间的相关性，采用Pearson相关检验(如果满足正态性检验)或Spearman相关检验(如果不满足正态性检验)和独立样本t检验评估生活质量与HD转移时间的关系。结果血红蛋白水平(p=0.244, r=-0.098)、BMI (p=0.473, r=-0.010)、HD时间(p=0.082)与患者的生活质量无相关性，而血清白蛋白(p=0.020, r=0.286)、Kt/V衡量的HD充分性(p=0.030, r=0.257)与患者的生活质量有显著相关性。结论血清白蛋白、Kt/V值与生活质量有显著相关性，而血红蛋白、BMI、透析移位时间与生活质量无相关性。
{"title":"Correlation between hemoglobin, serum albumin, body mass index, hemodialysis shift time and hemodialysis adequacy with quality of life in hemodialysis patients","authors":"D. Tanod, Linda Rotty, S. Palar, E. Moeis","doi":"10.32867/INAKIDNEY.V1I1.4","DOIUrl":"https://doi.org/10.32867/INAKIDNEY.V1I1.4","url":null,"abstract":"Background CKD Patients on routine hemodialysis (HD) are prone to medical complications and conditions that are potentially detrimental to the quality of life (QoL), such as anemia, malnutrition, low body mass index (BMI), HD shift time, and HD adequacy measured by Kt/V. CKD patients undergoing routine HD mostly have lowered QoL and are at higher risk for malnutrition, inflammation, hospitalization, and mortality, compared to the general population. This study intends to find out whether there is a correlation between these factors and the quality of life of patients undergoing routine hemodialysis. Methods The design of this study is a cross-sectional analysis of observational data. Hemodialysis patients from general hospital Prof. dr. R. D. Kandou Manado for 3 months from August to October 2017 were included. Fifty-two patients meet the inclusion and exclusion criteria. The correlation between quality of life with anemia, serum albumin, BMI, adequacy of HD, using Pearson correlation test (if normality test fulfilled) or Spearman correlation test (if the normality test not fulfilled) and Independent Samples T-test to assess the quality of life with HD shift time. Results This study found no correlation between hemoglobin levels (p=0.244, r=-0.098), BMI (p=0.473, r=-0.010), HD timing (p=0.082) and quality of life of the patients, but a significant correlation between serum albumin (p=0.020, r=0.286), HD adequacy measured by Kt/V (p=0.030, r=0.257) and subjects’ quality of life. Conclusion This study showed that serum albumin and Kt/V values had a significant correlation with quality of life, while hemoglobin, BMI and dialysis shift time are not related to the quality of life.","PeriodicalId":423107,"journal":{"name":"Indonesian Journal of Kidney and Hypertension","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125246377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-18DOI: 10.32867/INAKIDNEY.V1I1.7
Aditiawardana Aditiawardana, F. Liani, Chandra Irwanadi, N. Mardiana, Pranawa Pranawa
Background Calcineurin inhibitor (CNI) is a class of immunosuppressant agent used in kidney transplant management, known to pose risk for new-onset diabetes after transplant (NODAT). Tacrolimus and cyclosporine cause NODAT through multiple mechanisms, such as decreasing insulin secretion, increasing insulin resistance, and a direct effect on the pancreatic beta cell. Method This is a retrospective study on patients receiving immunosuppressant agents for kidney transplant patients in Surabaya. The immunosuppressant agents studied were CNI (tacrolimus and cyclosporine) in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroid. The blood glucose measured were fasting blood glucose (FBD) and 2-hour postprandial blood glucose (2PPBG). Objective Aim of this study is to determine the effect of calcineurin inhibitor (CNI) on glucose regulation in the nondiabetic renal transplant patient. Result Fifty-six subjects were included in the study, divided into two groups. One group of 28 patients (50%) received tacrolimus-MMF-MP and the other group received cyclosporine-MMF-MP. A significant increase in fasting blood glucose (pre-intervention level 86 ± 6 mg/dl vs post-intervention level 109 ± 34 mg/dl with p = 0.01) and 2-hour postprandial blood glucose (pre-intervention level 117 ± 20 mg/dl vs post-intervention level 150 ± 43 mg/dl with p < 0.001) was found in the tacrolimus group. A significant increase was also found in the cyclosporine group, both in fasting blood glucose (pre-intervention value 85 ± 7 mg/dl vs post-intervention value 97 ± 22 mg/dl with p = 0.002) and 2-hour postprandial blood glucose (pre-intervention value 119 ± 18 mg/dl vs post-intervention value 148 ± 55 mg/dl with p = 0.001). Tacrolimus was found to have a relative risk of NODAT up to 1.2 fold compared to cyclosporine. Conclusion Tacrolimus poses 1.29 relative risk of NODAT compared to cyclosporine. However, both drugs significantly increase fasting blood glucose and 2-hour postprandial blood glucose in non-diabetic patients receiving kidney transplantation.
钙调磷酸酶抑制剂(CNI)是一类用于肾移植管理的免疫抑制剂，已知可引起移植后新发糖尿病(NODAT)。他克莫司和环孢素通过多种机制引起NODAT，如减少胰岛素分泌、增加胰岛素抵抗、直接作用于胰腺β细胞等。方法对泗水地区肾移植患者接受免疫抑制剂治疗的情况进行回顾性研究。所研究的免疫抑制剂是CNI(他克莫司和环孢素)联合霉酚酸酯(MMF)或硫唑嘌呤(Aza)和类固醇。测定血糖为空腹血糖(FBD)和餐后2小时血糖(2PPBG)。目的探讨钙调磷酸酶抑制剂(calcalineurin inhibitor, CNI)对非糖尿病肾移植患者血糖调节的影响。结果共纳入56名受试者，分为两组。一组28例患者(50%)接受他罗莫司- mmf - mp治疗，另一组接受环氯孢素- mmf - mp治疗。他克莫司组空腹血糖(干预前水平为86±6 mg/dl，干预后水平为109±34 mg/dl, p = 0.01)和餐后2小时血糖(干预前水平为117±20 mg/dl，干预后水平为150±43 mg/dl, p < 0.001)显著升高。环孢素组空腹血糖(干预前为85±7 mg/dl，干预后为97±22 mg/dl, p = 0.002)和餐后2小时血糖(干预前为119±18 mg/dl，干预后为148±55 mg/dl, p = 0.001)均显著升高。与环孢素相比，他克莫司发生NODAT的相对风险高达1.2倍。结论他克莫司与环孢素相比，NODAT的相对危险度为1.29。然而，这两种药物均显著提高非糖尿病肾移植患者的空腹血糖和餐后2小时血糖。
{"title":"Effect of Calcineurin Inhibitor on Blood Glucose Level in Non-Diabetic Kidney Transplant Patients","authors":"Aditiawardana Aditiawardana, F. Liani, Chandra Irwanadi, N. Mardiana, Pranawa Pranawa","doi":"10.32867/INAKIDNEY.V1I1.7","DOIUrl":"https://doi.org/10.32867/INAKIDNEY.V1I1.7","url":null,"abstract":"Background Calcineurin inhibitor (CNI) is a class of immunosuppressant agent used in kidney transplant management, known to pose risk for new-onset diabetes after transplant (NODAT). Tacrolimus and cyclosporine cause NODAT through multiple mechanisms, such as decreasing insulin secretion, increasing insulin resistance, and a direct effect on the pancreatic beta cell. Method This is a retrospective study on patients receiving immunosuppressant agents for kidney transplant patients in Surabaya. The immunosuppressant agents studied were CNI (tacrolimus and cyclosporine) in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroid. The blood glucose measured were fasting blood glucose (FBD) and 2-hour postprandial blood glucose (2PPBG). Objective Aim of this study is to determine the effect of calcineurin inhibitor (CNI) on glucose regulation in the nondiabetic renal transplant patient. Result Fifty-six subjects were included in the study, divided into two groups. One group of 28 patients (50%) received tacrolimus-MMF-MP and the other group received cyclosporine-MMF-MP. A significant increase in fasting blood glucose (pre-intervention level 86 ± 6 mg/dl vs post-intervention level 109 ± 34 mg/dl with p = 0.01) and 2-hour postprandial blood glucose (pre-intervention level 117 ± 20 mg/dl vs post-intervention level 150 ± 43 mg/dl with p < 0.001) was found in the tacrolimus group. A significant increase was also found in the cyclosporine group, both in fasting blood glucose (pre-intervention value 85 ± 7 mg/dl vs post-intervention value 97 ± 22 mg/dl with p = 0.002) and 2-hour postprandial blood glucose (pre-intervention value 119 ± 18 mg/dl vs post-intervention value 148 ± 55 mg/dl with p = 0.001). Tacrolimus was found to have a relative risk of NODAT up to 1.2 fold compared to cyclosporine. Conclusion Tacrolimus poses 1.29 relative risk of NODAT compared to cyclosporine. However, both drugs significantly increase fasting blood glucose and 2-hour postprandial blood glucose in non-diabetic patients receiving kidney transplantation.","PeriodicalId":423107,"journal":{"name":"Indonesian Journal of Kidney and Hypertension","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128571604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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