Reduction in New Onset Diabetes after Renal Transplant with Erythropoietin Stimulating Agents, a Case Control Study
Nephrology, St.Michaels Hospital, Toronto, ON, Canada
Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Endocrinology and Metabolism, St. Michaels, Toronto, ON, Canada
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada
Renal Transplant Reasearch, St. Michaels Hospital, Toronto, ON, Canada
Meeting: 2013 American Transplant Congress
Abstract number: D1477
Background: New-onset diabetes mellitus after transplantation (NODAT) adversely affects graft and patient survival. Approximately 10-15 % of post-renal transplant patients require an erythropoietin stimulating agent (ESA) for the treatment of anemia. Studies have shown that ESA protects mice against the development of diabetes through direct effects on pancreatic ß cells. However, the effect of ESA on the risk of diabetes in humans has not been well studied.
Methods: We performed a case control analysis of patients with NODAT who received a first live or deceased donor renal allograft between January 1, 2005 and December 31, 2010, comparing those with exposure to an ESA versus those without such exposure. Patients with a prior history of diabetes mellitus or more than one renal transplant were excluded. NODAT was defined based on the 2008 Canadian Diabetes Association criteria or need for anti-diabetic agents (oral or insulin). Multivariate logistic regression analysis was performed to determine factors independently associated with NODAT including age, body mass index (BMI), acute rejection (AR), donor source and random blood sugar (RBS) at discharge.
Results: 615 recipients met initial criteria. 153 were excluded. In the remaining 462, 62 (13.4%) had NODAT whereas 400(86.6%) did not. 21% of recipients with NODAT were exposed to an ESA compared to 79% who were not. By Fisher exact test, exposure to an ESA within the first 6 months post transplant reduced the risk of developing NODAT by 94% (OR=0.063, CI= 0.008-0.493, p= 0.012). Increasing age (OR=1.422, CI= 1.077-1.932, p < 0.0001) and RBS at discharge (OR 1.39, CI=1.167-1.658, p< 0.0001) were associated with an increased risk of NODAT, however even accounting for these factors by multivariate analysis, ESA exposure remained protective.
Conclusion: The risk for developing NODAT was significantly reduced in patients who were exposed to an ESA compared to those who were not exposed. There may be a role for ESAs in preventing NODAT particularly if given within the first 6 months of transplant, although this remains hypothesis generating.
To cite this abstract in AMA style:
Montada-Atin T, Choi D, Woo M, Retnakaran R, Huang M, Prasad G, Zaltzman J. Reduction in New Onset Diabetes after Renal Transplant with Erythropoietin Stimulating Agents, a Case Control Study [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/reduction-in-new-onset-diabetes-after-renal-transplant-with-erythropoietin-stimulating-agents-a-case-control-study/. Accessed May 14, 2025.« Back to 2013 American Transplant Congress