Dysglycemia among kidney transplant recipients at Kenyatta National Hospital

Abstract

Diabetes mellitus (DM) is the commonest cause of end stage renal disease worldwide. There is an increased incidence of DM in the third world countries, Kenya being one of them. Evidence has shown that kidney transplantation is the best treatment for end stage kidney disease (ESKD). It improves health related quality of life and prevents complications of kidney failure. Higher incidence of dysglycemia among kidney transplant recipients (KTRs) has been documented. This makes them more susceptible to fatal cardiovascular events. Preventing, detecting and treating the dysglycemia early in KTR have beneficial effects. Objectives of the study: The primary objective of our study was to determine the prevalence of dysglycemia {pre transplant DM, new onset diabetes after transplantation (NODAT), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)} among KTRs at Kenyatta National Hospital (KNH). Secondary objectives were to determine quality of glycemic control in the known diabetic patients and to describe the clinical characteristics of the KTRs with dysglycemia. Methods We did a cross-sectional, descriptive hospital based study at the transplant clinic at the renal unit of KNH. All adults (aged 18 and above) KTRs, who agreed to participate were included with a minimum targeted sample of 103. Study questionnaire was filled after a signed written consent was obtained. Patients’ weight, height and waist circumference were later measured by principal investigator (PI) and later blood samples were taken for glycated hemoglobin c (HbA1c) percent for the diabetic patients, and fasting blood sugar (FBS) and oral glucose tolerance test (OGTT) for the rest to determine presence of dysglycemia. Data was managed in Microsoft Access 2013 database. Study population was described using their socio demographic and clinical characteristics. Statistical package for social sciences (SPSS) version 21.0 software was used for statistical analysis. The prevalence of dysglycemia was analyzed and presented as a percentage of all KTRs and a 95% confidence interval (CI) of the prevalence was presented. T test method was used to compare continuous data and chi-square test for categorical data. Univariate and

multivariate analyses were performed to investigate associations between patient characteristics and dysglycemia. Results Between September 2016 and May 2017, 105 kidney transplant recipients were recruited in the study and we found a prevalence of 13.3% for new onset diabetes after transplantation (NODAT), 14.29% for impaired glucose tolerance (IGT) and 6.67% for impaired fasting glucose (IFG). The prevalence of pre transplant DM was 23.81%. Important risk factors noted at univariate analysis were female gender, longer duration post transplantation, BMI more that 25kg/m2, higher waist hip ratios and family history of diabetes. There were no independent associations found at multivariate analysis. More than half of the diabetes KTRs had poor glycemic control (56%) with a mean HbA1c of 8.4±2.1 percent. Conclusion We found a high prevalence of dysglycemia in our set up and also poor glycemic control in KTRs with diabetes mellitus. This calls for improved screening programs on KTRs who previously were non diabetic and intensive risk stratification to optimize graft survi