HbA1c changes in the first year post-kidney transplant and associated risk factors in a Saudi cohort

Abstract

Background: There is limited data about the risk factors of clinically significant glycosylated hemoglobin (HbA1c) change and post-transplant diabetes mellitus (PTDM) in the first year post-kidney transplantation (KT), especially in the Middle East. Objectives: To determine the trends of HbA1c levels, the risk factors associated with HbA1c increases, and predictors of clinically significant HbA1c change and PTDM in the first year post-KT. Design: Retrospective chart review. Methods: We included all KT recipients (KTRs) at our center from 2017 until 2020. The study focused on reviewing the patients’ demographic information, cardiovascular risk factors, and HbA1c values at baseline, 6 months, and 12 months. Results: A total of 203 KTRs were included. The mean age of the participants was 44.7 ± 15.5 years, 59.1% were men, and 80.3% received living donors. Eighty-two (40.4%) KTRs had pre-KT diabetes. At 12 months post-KT, the total HbA1c change was 0.87 ± 1.6. In total, 130 (64.04%) KTRs demonstrated clinically significant HbA1c change, and 19 (15.7%) nondiabetics developed PTDM. Pre-KT diabetics suffered greater increases than their nondiabetic counterparts (0.8 vs 0.6, p = 0.043). Increased age (adjusted odds ratio (aOR) = 1.053), weight change (aOR = 1.055), pre-KT hypertension (aOR = 3.015), and lower baseline HbA1c (aOR = 0.453) were independently associated with clinically significant HbA1c change. PTDM patients were older ( p = 0.007) and had higher HbA1c levels at baseline ( p = 0.033), 6 months ( p = 0.002), and 1-year post-KT ( p = 0.001). Gender, type of KT, dialysis, and cardiovascular risk factors were not different between PTDM and non-PTDM patients. Abnormal perfusion tests ( p < 0.001) and coronary artery disease on coronary angiogram ( p = 0.046) were more common in PTDM patients. Only age was independently associated with the presence of PTDM at 1-year post-KT (aOR = 1.044). Conclusion: The incidence rate of PTDM in Saudi KT patients is similar to that of other populations. Several risk factors, including low baseline HbA1c and pre-KT hypertension, predict a clinically significant change in HbA1c. Patients with these risk factors may require stricter monitoring and control of HbA1c.