Post-donation diabetes

STUDY OF THE RISK FACTORS AND THE
COMPLICATIONS OF DIABETES MELLITUS
AFTER LIVE KIDNEY DONATION.
Mohammed M Abuelmagd, Ayman M Nagib,
Megahed M Abuelmagd, , Ayman F Refaie , Yasser A
Elhindi, Mohammed F Ahmed, Mohammed H Ali,
Hanzada M Elmaghrabi and Mohammed A Bakr
21stMay2014UNC

INTRODUCTION & AIM OF THE WORK
 Renal transplantation is the golden method
for management of end-stage renal disease
and kidney transplant recipients have a
higher quality of life and consume fewer
health care resources compared with
patients on dialysis.
 Living kidney donation has become an
essential part of transplantation practice.
 Shortage of deceased donors.
 The growing waiting lists.
 Tendency for pre-emptive transplantation.
21stMay2014UNC
(Yoo et al., 2009) , (Fuggle et al., 2010).

 Diabetes mellitus is the leading cause of end-
stage renal disease.
 Diabetes mellitus is an absolute
contraindication to living donation.
Prospective donors with an increased risk of
type 2 diabetes mellitus because of family
history, ethnicity or obesity should undergo a
glucose tolerance test and only be considered
further as donors if this is normal.
21stMay2014UNC
(Fehrman et al.,1996), (Bethesda., 2007).

 This line of post-donation researches
initiated in our center mainly aims to
identify potential medical burdens of live
kidney donation, design prevention
protocols ,modify donor inclusion-exclusion
criteria and finally to inform donors about
the potential risks of donation.
 This research aim is to:-
1. Estimate the prevalence of diabetes mellitus after
live kidney donation.
2. Assess some risk factors for diabetes mellitus and
their impact on developing the studied chronic
complications after live kidney donation.
3. Study some chronic complications of diabetes
mellitus after live kidney donation.
21stMay2014UNC
(Fehrman et al.,1996), (Bethesda., 2007).

METHODS
1. Pre-Operative collected data:
1. Age at time of donation.
2. Family history of diabetes mellitus.
3. Body mass index (BMI) at the time of donation.
4. Blood pressure at time of donation.
5. Fasting and two hour post prandial blood glucose.
6. Creatinine clearance by 24 hour urine collection method.
7. Measurement of 24 hour urinary protein excretion.
2. Post-Operative collected data:
1. Serial monitoring of donors BMI.
2. Serial Monitoring of blood pressure.
3. Type of antihypertensive treatment if present.
4. Serial measurement of Fasting blood sugar levels.
5. Type of anti-hyperglycemic treatment.
6. Serial monitoring of post-donation albumin creatinine ratio.
7. Serial monitoring of estimated creatinine clearance by the
application of the CKD-EPI equation.
8. Serial monitoring of lipid profile post-donation.
9. Fundus Examination for the diabetic donors only.
UNC21stMay2014

RESULTS & DISCUSSION
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388 Studied Donors 85.25 million 2013 National
Egyptian population
Diabetic PopulationDiabetic Donors

Prediabetic Donors
Prediabetic Population
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Egyptian population
P <0.0001

Disturbed glucose
homeostasis Donors
Disturbed glucose
homeostasis Population
UNC21stMay2014
Egyptian population
P <0.0001

18-25 n=122
25-30 n=149
>30 n=117
4.1% 6%
24.7%
DM %
BMI kg/m2
n=(number of donors)
Percentage of DM among different donor
BMI groups
UNC21stMay2014

UNC21stMay2014
Mean BMI difference pre- and post-donation.
0
5
10
15
20
25
30
35
40
45
Pre-donation Post-Donation

UNC21stMay2014
Diabetic donors
388 Studied Donors
Very high
albuminuria
(Macroalbu
minuria)
High
albuminuria
(Microalbu
minuria)
Normal
albumin
excretion
Percentage of microalbuminuric,
macroalbuminuric and
normoalbuminuric diabetic donors

UNC21stMay2014
Prediabetic donors
388 Studied Donors
Very high
albuminuria
(Macroalbu
minuria)
High
albuminuria
(Microalbu
minuria)
Normal
albumin
excretion
Percentage of microalbuminuric,
macroalbuminuric and
normoalbuminuric prediabetic
donors

Diabetic donors with high, very high
albuminuria &or decreased Crcl and positive
family history for DM
UNC21stMay2014
Diabetic donors with positive
family history for DM
25 Donors with urinary ACR
above 30 mg/g and or
decreased Clearance below 70
ml/min
Frequency of diabetes mellitus and high, very high albuminuria &or
decreased eCrcl among diabetic donors with a family history of DM
compared to diabetic donors with no family history of DM.
43 studied diabetic
donors

 Correlation between BMI and urinary albumin
creatinine ratio in the whole studied group.
UNC21stMay2014

CONCLUSION
 The incidence of post-donation DM in this study was lower than the
general Egyptian population. However, the incidence of micro-
macroalbuminuria and/or decreased creatinine clearance was significantly
higher than other studies.
 The impact of family history of DM was found highly significant especially
on the development of post-donation abnormal albumin execretion.
 Also there was a positive correlation between the albumin creatinine ratio
and post-donation BMI.
 Diabetic donors on RAS blockade, Metformin and insulin showed
improvement in albumin creatinine ratio levels and or estimated
creatinine clearance. However, donors on other oral hypoglycemic agents,
metformin combination with sulfonylureas and other types of
antihypertensive medications showed deterioration of albumin creatinine
ratio and or creatinine clearance.
UNC21stMay2014

RECOMMENDATIONS
 As regard the study:-
 Multiple transplant centers should collaborate in a
larger randomized control trial researching live
kidney donation related morbidities.
 As regard donor follow ups:-
 Meticulous post-live kidney donation follow ups may
improve the outcome of the transplant process and
increase the donor pool.
UNC21stMay2014

RECOMMENDATIONS
 As regard donor selection protocols.
 We must consider reducing the cutoff point of BMI exclusion, and
most importantly to strongly advice donors not to gain Weight after
donation giving the positive correlation between BMI and urinary
albumin creatinine ratio post-donation.
 We must also consider exclusion of donors with two or more members
of the first degree relatives with a history of diabetes mellitus giving
the impact of the family history of diabetes on both development of
diabetes and diabetic nephropathy in particular. High risk consent
should be obtained if the previously described donors still highly
motivated to continue the preparation process.
 Donors with impaired fasting and/or impaired glucose tolerance
should be excluded from the preparation program.
 Donors with hyperlipidemia should be considered marginal donors.
Giving the positive correlation between the serum total cholesterol
levels and the urinary albumin creatinine ratio.
UNC21stMay2014

RECOMMENDATIONS
 As regard post-donation follow up policy.
 Fasting and two hour post prandial blood glucose levels should be performed as frequent as
possible for early diagnosis of diabetes or prediabetes.
 We must consider albuminuria preventive measures in both pre-diabetics and diabetics. For
example, we should consider starting a small dose of RAS blockade even in normotensive
diabetic and pre-diabetic donors.
 We should strongly advise obese donors to start modifying their lifestyles aiming to reduce
their weights giving the positive correlation between both the BMI and urinary albumin
creatinine ratio.
 We should have a lower threshold of starting metformin giving its proven beneficial effects on
both urinary albumin creatinine ratio and creatinine clearance.
 On failure of metformin to achieve the desired glycemic control we should add insulin giving
its proven beneficial effects on both urinary albumin creatinine ratio and creatinine
clearance.
 We should consider avoiding metformin combination with sulfonylureas as this combination
caused deterioration in both renal function and urinary albumin excretion in the studied
diabetic donors.
 Antihyperlipidemic agents should be started as early as possible giving the positive
correlation between the serum total cholesterol levels and urinary albumin creatinine ratio.
UNC21stMay2014

Post-donation diabetes

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