Serum uric acid is associated with increased risk of posttransplantation diabetes in kidney transplant recipients: a prospective cohort study

Serum uric acid (SUA) is associated with fasting glucose in healthy subjects, and prospective epidemological studies have shown that elevated SUA is associated with increased risk of type 2 diabetes. Whether SUA is independently associated with higher risk of posttransplantation diabetes mellitus (P...

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Published in:Metabolism, clinical and experimental clinical and experimental, 2021-03, Vol.116, p.154465-154465, Article 154465
Main Authors: Sotomayor, Camilo G., Oskooei, Sara Sokooti, Bustos, Nicolás I., Nolte, Ilja M., Gomes-Neto, António W., Erazo, Marcia, Gormaz, Juan G., Berger, Stefan P., Navis, Gerjan J., Rodrigo, Ramón, Dullaart, Robin P.F., Bakker, Stephan J.L.
Format: Article
Language:English
Subjects:
Adult
Aged
Cohort Studies
Diabetes Mellitus, Type 2 - blood
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - etiology
Female
Glomerular Filtration Rate
Humans
Inflammation
Kidney transplantation
Kidney Transplantation - adverse effects
Longitudinal Studies
Male
Metabolic syndrome
Middle Aged
Oxidative stress
Posttransplantation diabetes
Prospective Studies
Risk Factors
Transplant Recipients
Uric acid
Uric Acid - blood
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cited_by cdi_FETCH-LOGICAL-c412t-d08a8231eda45e787667c0e9b0643231c13a2c5c40132cb15728be9e8363e1c73
cites cdi_FETCH-LOGICAL-c412t-d08a8231eda45e787667c0e9b0643231c13a2c5c40132cb15728be9e8363e1c73
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container_title Metabolism, clinical and experimental
container_volume 116
creator Sotomayor, Camilo G.
Oskooei, Sara Sokooti
Bustos, Nicolás I.
Nolte, Ilja M.
Gomes-Neto, António W.
Erazo, Marcia
Gormaz, Juan G.
Berger, Stefan P.
Navis, Gerjan J.
Rodrigo, Ramón
Dullaart, Robin P.F.
Bakker, Stephan J.L.
description Serum uric acid (SUA) is associated with fasting glucose in healthy subjects, and prospective epidemological studies have shown that elevated SUA is associated with increased risk of type 2 diabetes. Whether SUA is independently associated with higher risk of posttransplantation diabetes mellitus (PTDM) in kidney transplant recipients (KTR) remains unknown. We performed a longitudinal cohort study of 524 adult KTR with a functioning graft ≥1-year, recruited at a university setting (2008–2011). Multivariable-adjusted Cox proportional-hazards regression analyses were performed to assess the association between time-updated SUA and risk of PTDM (defined according the American Diabetes Association's diagnostic criteria). Mean (SD) SUA was 0.43 (0.11) mmol/L at baseline. During 5.3 (IQR, 4.1–6.0) years of follow-up, 52 (10%) KTR developed PTDM. In univariate prospective analyses, SUA was associated with increased risk of PTDM (HR 1.75, 95% CI 1.36–2.26 per 1-SD increment; P 50%).•Calcineurin inhibitors, specially cyclosporine, associate with higher uric acid.•Higher uric acid is associated with increased risk of posttransplant diabetes•Uric acid-targeted care may aid on decreasing the burden of posttranplant diabetes.
doi_str_mv 10.1016/j.metabol.2020.154465
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Whether SUA is independently associated with higher risk of posttransplantation diabetes mellitus (PTDM) in kidney transplant recipients (KTR) remains unknown. We performed a longitudinal cohort study of 524 adult KTR with a functioning graft ≥1-year, recruited at a university setting (2008–2011). Multivariable-adjusted Cox proportional-hazards regression analyses were performed to assess the association between time-updated SUA and risk of PTDM (defined according the American Diabetes Association's diagnostic criteria). Mean (SD) SUA was 0.43 (0.11) mmol/L at baseline. During 5.3 (IQR, 4.1–6.0) years of follow-up, 52 (10%) KTR developed PTDM. In univariate prospective analyses, SUA was associated with increased risk of PTDM (HR 1.75, 95% CI 1.36–2.26 per 1-SD increment; P &lt; 0.001). This finding remained materially unchanged after adjustment for components of the metabolic syndrome, lifestyle, estimated glomerular filtration rate, immunosuppressive therapy, cytomegalovirus and hepatitis C virus infection (HR 1.89, 95% CI 1.32–2.70; P = 0.001). These findings were consistent in categorical analyses, and robust in sensitivity analyses without outliers. In KTR, higher SUA levels are strongly and independently associated with increased risk of PTDM. Our findings are in agreement with accumulating evidence supporting SUA as novel independent risk marker for type 2 diabetes, and extend the evidence, for the first time, to the clinical setting of outpatient KTR. •Hyperuricemia is highly frequent in outpatient kidney transplant recipients (&gt;50%).•Calcineurin inhibitors, specially cyclosporine, associate with higher uric acid.•Higher uric acid is associated with increased risk of posttransplant diabetes•Uric acid-targeted care may aid on decreasing the burden of posttranplant diabetes.</description><identifier>ISSN: 0026-0495</identifier><identifier>EISSN: 1532-8600</identifier><identifier>DOI: 10.1016/j.metabol.2020.154465</identifier><identifier>PMID: 33316268</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Cohort Studies ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - etiology ; Female ; Glomerular Filtration Rate ; Humans ; Inflammation ; Kidney transplantation ; Kidney Transplantation - adverse effects ; Longitudinal Studies ; Male ; Metabolic syndrome ; Middle Aged ; Oxidative stress ; Posttransplantation diabetes ; Prospective Studies ; Risk Factors ; Transplant Recipients ; Uric acid ; Uric Acid - blood</subject><ispartof>Metabolism, clinical and experimental, 2021-03, Vol.116, p.154465-154465, Article 154465</ispartof><rights>2020 The Author(s)</rights><rights>Copyright © 2020 The Author(s). 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Whether SUA is independently associated with higher risk of posttransplantation diabetes mellitus (PTDM) in kidney transplant recipients (KTR) remains unknown. We performed a longitudinal cohort study of 524 adult KTR with a functioning graft ≥1-year, recruited at a university setting (2008–2011). Multivariable-adjusted Cox proportional-hazards regression analyses were performed to assess the association between time-updated SUA and risk of PTDM (defined according the American Diabetes Association's diagnostic criteria). Mean (SD) SUA was 0.43 (0.11) mmol/L at baseline. During 5.3 (IQR, 4.1–6.0) years of follow-up, 52 (10%) KTR developed PTDM. In univariate prospective analyses, SUA was associated with increased risk of PTDM (HR 1.75, 95% CI 1.36–2.26 per 1-SD increment; P &lt; 0.001). This finding remained materially unchanged after adjustment for components of the metabolic syndrome, lifestyle, estimated glomerular filtration rate, immunosuppressive therapy, cytomegalovirus and hepatitis C virus infection (HR 1.89, 95% CI 1.32–2.70; P = 0.001). These findings were consistent in categorical analyses, and robust in sensitivity analyses without outliers. In KTR, higher SUA levels are strongly and independently associated with increased risk of PTDM. Our findings are in agreement with accumulating evidence supporting SUA as novel independent risk marker for type 2 diabetes, and extend the evidence, for the first time, to the clinical setting of outpatient KTR. •Hyperuricemia is highly frequent in outpatient kidney transplant recipients (&gt;50%).•Calcineurin inhibitors, specially cyclosporine, associate with higher uric acid.•Higher uric acid is associated with increased risk of posttransplant diabetes•Uric acid-targeted care may aid on decreasing the burden of posttranplant diabetes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33316268</pmid><doi>10.1016/j.metabol.2020.154465</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record>
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ispartof Metabolism, clinical and experimental, 2021-03, Vol.116, p.154465-154465, Article 154465
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1532-8600
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source ScienceDirect Freedom Collection
subjects Adult
Aged
Cohort Studies
Diabetes Mellitus, Type 2 - blood
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - etiology
Female
Glomerular Filtration Rate
Humans
Inflammation
Kidney transplantation
Kidney Transplantation - adverse effects
Longitudinal Studies
Male
Metabolic syndrome
Middle Aged
Oxidative stress
Posttransplantation diabetes
Prospective Studies
Risk Factors
Transplant Recipients
Uric acid
Uric Acid - blood
title Serum uric acid is associated with increased risk of posttransplantation diabetes in kidney transplant recipients: a prospective cohort study
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