The Role of Proteinuria, Paricalcitol and Vitamin D in the Development of Post-Transplant Diabetes Mellitus after Kidney Transplantation

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Abstract

Introduction

The post-transplant diabetes mellitus (PTDM) occurs most frequently during the first year after the transplantation. We focused on parameters of calcium-phosphate metabolism and proteinuria as possible new risk factors for PTDM after kidney transplantation.

Materials and Methods

We have prospectively identified in a set of 167 patients after kidney transplantation risk factors for post-transplant diabetes mellitus with follow-up of 12 months. Patients with diabetes mellitus type 1 and type 2 as well as patients using ciclosporin A or mTOR inhibitor have been excluded from the monitoring. From the perspective of immunosuppression it was a homogeneous set of patients.

Results

We identified the following independent risk factors for PTDM in our set: average proteinuria >0,300 g/24 hours [HR 3.0785, (95 % CI 1.6946-5.5927), P = 0.0002], level of vitamin D < 20 ng/ml [HR 5.4517, (95 % CI 2.3167-11.8209), P <0.0001] base line serum level of phosphorus >1.45 mmol/l [HR0.0821, (95 % CI0.0042-1.5920), P = 0.0439]. The lowest occurrence of PTDM and proteinuria was recorded in patients whose treatment included paricalcitol (P <0.0001) and these patients had at the same time the highest level of vitamin D (P <0.0001).

Conclusion

Deficit of vitamin D, proteinuria and hyperphosphatemia are independent risk factors for the development of PTDM in our set. We identified the usage of paricalcitol as protective factor with regard to the PTDM development.

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