Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant

Israni, Ajay K.; Snyder, Jon J.; Skeans, M. A.; Kasiske, Bertram L.

doi:10.1111/j.1432-2277.2012.01488.x

Cited by 59 publications

(46 citation statements)

References 38 publications

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“…Novel targets continue to be identified, incorporating an improved understanding of metabolic syndrome and identification of select genetic polymorphisms as PTDM risk factors. Israni et al (26) found posttransplant metabolic syndrome independently associated with subsequent risk of PTDM. When occurring pretransplantation, the metabolic syndrome (27) and its components such as pretransplant hypertriglyceridemia and BMI (28), as well as prediabetes (17) have predicted increased risk for PTDM.…”

Section: Recommendation 4: Identify Patients At Risk For Ptdmmentioning

confidence: 99%

Proceedings From an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions

Sharif

Hecking

Vries

et al. 2014

American Journal of Transplantation

443

471

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A consensus meeting was held in Vienna on September 8–9, 2013, to discuss diagnostic and therapeutic challenges surrounding development of diabetes mellitus after transplantation. The International Expert Panel comprised 24 transplant nephrologists, surgeons, diabetologists and clinical scientists, which met with the aim to review previous guidelines in light of emerging clinical data and research. Recommendations from the consensus discussions are provided in this article. Although the meeting was kidney-centric, reflecting the expertise present, these recommendations are likely to be relevant to other solid organ transplant recipients. Our recommendations include: terminology revision from new-onset diabetes after transplantation to posttransplantation diabetes mellitus (PTDM), exclusion of transient posttransplant hyperglycemia from PTDM diagnosis, expansion of screening strategies (incorporating postprandial glucose and HbA1c) and opinion-based guidance regarding pharmacological therapy in light of recent clinical evidence. Future research in the field was discussed with the aim of establishing collaborative working groups to address unresolved questions. These recommendations are opinion-based and intended to serve as a template for planned guidelines update, based on systematic and graded literature review, on the diagnosis and management of PTDM.

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Section: Recommendation 4: Identify Patients At Risk For Ptdmmentioning

confidence: 99%

Proceedings From an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions

Sharif

Hecking

Vries

et al. 2014

American Journal of Transplantation

443

471

View full text Add to dashboard Cite

show abstract

“…Even though some of these factors also define metabolic syndrome, the specific role of metabolic syndrome in the development of diabetes has not been completely clarified yet. However, three recently published studies have shed some light on this matter, showing that diagnosis of metabolic syndrome after renal transplant23,24 and within the month prior to transplant25 was associated with an increased risk of NODAT.…”

Section: Introductionmentioning

confidence: 99%

Metabolic syndrome in hemodialysis patients as a risk factor for new-onset diabetes mellitus after renal transplant: a prospective observational study

Bonet¹,

Martinez-Castelao²,

Bayés³

2013

DMSO

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PurposeMetabolic syndrome is a cluster of biochemical abnormalities including cardiovascular and diabetes risk factors. The development of diabetes mellitus after renal transplant represents a major posttransplant complication that may adversely affect graft/patient survival. The aim of this study was to assess the role of metabolic syndrome in patients on hemodialysis as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant.Patients and methodsThis was a prospective observational epidemiologic study carried out in adult nondiabetic patients undergoing chronic hemodialysis and on the renal transplant waiting list between November 2008 and April 2009. Patients were followed up from Visit 1 (baseline) to 6 months after the renal transplant. The analysis of the role of metabolic syndrome in hemodialysis patients as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant included the estimation of relative risk and its 95% confidence interval (CI).ResultsA total of 383 evaluable patients were entered into the study (mean age, 52.7 years; male, 57.7%; Caucasian, 90.1%). The prevalence of metabolic syndrome on hemodialysis was 30.4% (95% CI, 25.8%–35.4%). Hypertension was the most prevalent criterion for metabolic syndrome (65.0%), followed by low levels of high-density lipoprotein cholesterol (52.7%), abdominal obesity (36.2%), hypertriglyceridemia (32.4%), and impaired glucose (8.9%). After the renal transplant, the prevalence of metabolic syndrome was still 25.8%. During the posttransplant period, the incidence of new-onset diabetes mellitus reached 13.0% (95% CI, 7.8%–20.6%) and patients with pretransplant metabolic syndrome were 2.6 times (95% CI, 1.043–6.608) more likely to develop new-onset diabetes mellitus after the renal transplant than those without metabolic syndrome.ConclusionThe presence of metabolic syndrome in patients undergoing hemodialysis represents an independent risk factor for the incidence of new-onset diabetes mellitus after renal transplant.

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“…Obesity in RTRs is strongly linked to the development of metabolic syndrome, with around 60% of patients meeting the diagnostic criteria [103] at transplantation and 9%63% in the subsequent years [104,105] . It is independently associated with longterm graft function and is a prominent risk for allograft failure [105] and CV events secondary to atherosclerosis [106] . The cumulative incidence of coronary heart disease events by 60 mo posttransplant was 5.9% in transplant recipients with metabolic syndrome, compared with 2.3% in recipients without metabolic syndrome.…”

Section: Lifestyle Factorsmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

119

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant

Cited by 59 publications

References 38 publications

Proceedings From an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions

Proceedings From an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions

Metabolic syndrome in hemodialysis patients as a risk factor for new-onset diabetes mellitus after renal transplant: a prospective observational study

Cardiovascular risk factors following renal transplant

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