Şebnem KARAKAN, Siren SEZER, Özdemir ACAR, Fatma NURHAN

Böbrek nakli sonrası yeni diyabetes mellitus gelişmesine etki eden faktörler; obezite ve inflamasyonun rolü

Amaç: Organ naklinden sonra alıcıda yeni gelişen diabetes mellitus (DM) %50’e ulaşan oranda görülen metabolik bir komplikasyondur. Biz bu çalışmada kliniğimizde böbrek nakli sonrası yeni gelişen DM sıklığına katkısı olan faktörleri analiz edildi. Gereç ve Yöntem: Çalışmamızda 1995 ve 2008 yılları arasında böbrek nakli olan ve nakilden 2 yıl sonra greft fonksiyonu devam eden 236 (Ortalama yaş 41±12 yıl; %75 erkek) hastayı retrospektif olarak değerlendirdik. Böbrek nakli sırasında DM tanısı olanlar (n=23), nakil sonrası ilk 2 yıl içinde greft kaybı olanlar (n =16), akut rejeksiyon, konjestif kalp yetmezliği ve aktif enfeksiyonu olanlar (n = 19), ve bilgileri eksik olan hastalar (n=3) çalışma dışı bırakıldı. Böbrek naklinden 2 yıl sonraki takipte 34 hastada (%19.4) yeni gelişen DM tespit edildi (grup 1). DM tanısı almamış kalan 141 hastayı grup 2 olarak kabul ettik. Çalışmaya dahil edilen hastaların başlangıç ve DM tanısı aldığı zamana ait klinik, demografik özellikleri ve tüm laboratuvar özelliklerini kaydettik. Bulgular: Grup 1 hastaların yaş, Beden Kitle İndeksi (BKİ), ürik asit, LDL kolesterol, C-reaktif protein, değerleri istatiksel olarak grup 2 hastalarına göre yüksek bulundu. Her iki grupta 2 yılın sonunda kilo alım oranları eşit tespit edildi. (%6.8±5.2 ve %5.2±2.9, p=0.08). İmmunsupresif tedavilerine göre yapılan incelemede siklosporin ve takrolimus alan hastalarda yeni ortaya çıkan DM oranları eşit bulundu. Sonuç: Böbrek nakli olan hastalarda iki yılın sonunda kilo alım oranları etkili olmazken nakil esnasındaki BKİ oranları yeni ortaya çıkan DMi gelişi- minde etkilidir. Risk faktörlerinin yakın takibi ve ortadan kaldırılması bu komplikasyonun görülme sıklığını azaltacaktır.

Obesity and inflammation as predictors of new-onset diabetes mellitus after kidney transplantation

Objective: The clinical impact of new-onset diabetes mellitus (DM) after renal transplantation (RT) is frequently underestimated by clinicians. DM after transplantation is a leading risk factor for cardiovascular events. We aimed to identify post-RT risk factors for NODM. Materials and Methods: We retrospectively analyzed 236 non-diabetic patients (mean age 41±12 years; %75 male) between 1995 and 2008. We excluded those diagnosed as DM mellitus at RT time (n=23), greft loss during the two years (n =16), acute rejection, congestive heart failure, active infections (n =19), and those for whom data was not fully available (n=3). At 2 years of follow-up after RT, 34 (19.4%) patients developed DM (group 1). One hundred fourthy one non-diabetic patients were defined as group 2. We have recorded parameters at the time of DM diagnosis such as demographic features, medications, smoking history, blood pressure, daily proteinuria. Results: Age, body mass index, uric acid, sodium, LDL-cholesterol, CRP values were significantly higher in group 1. The percentage of weight gain (6.8%±5.2 vs. 5.2%±2.9, p=0.08) were similar in two groups. The prevalence of DM was similar between patients under CyA and TAC based immu- nosuppression. Conclusions: Baseline BMI, but not the weight gain at 2 years after RT, is an independent risk factor for DM. Importantly, overweight recipients within the high-risk group had raised inflammatory markers. Tailoring clinical strategies may minimize the impact of this complication.

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