The role of proteinuria, paricalcitol and vitamin D in the development of post-transplant diabetes mellitus

Abstract

INTRODUCTION: Post-transplant diabetes mellitus (PTDM) occurs most frequently during the fi rst year after 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 identifi ed risk factors for post-transplant diabetes mellitus with follow-up of 12 months in a set of 167 patients after kidney transplantation. 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 identifi ed the following independent risk factors for PTDM in our set: average proteinuria > 0.300 g/24 h (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) baseline 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: Defi cit of vitamin D, proteinuria and hyperphosphatemia have been independent risk factors for the development of PTDM in our set. We identifi ed the usage of paricalcitol as protective factor with regard to the PTDM development.