One of the first studies to evaluate the use of diuretics in kidney transplant recipients showed that diuretic use after kidney transplantation significantly increased the risk of progression to diabetes, potentially leading to diabetes. to serious complications including graft rejection.

“Post-transplantation diabetes mellitus (PTDM) can be the reason for many complications for kidney transplant patients because they are very vulnerable patients and the treatment of diabetes It is also very difficult because the kidney function is not threshold enough to meet,” researcher Sara Oskooei, M.D., PhD candidate, University Medical Center, Groningen, Netherlands, told Medscape Medical journal.

“So I think as a nephrologist we need to develop some risk models for diabetics after a kidney transplant, and categorize our kidney transplant recipients as at risk. higher and lower risk of diabetes, then individualized to access treatment, in patients at low risk may still benefit from the use of diuretics but for patients at risk If you have a high chance of getting diabetes, you won’t,” she added.

Oskooei presented his results at the annual meeting of the European Society of Nephrology – European Society of Artificial Kidneys and Transplants (ERA-EDTA) in 2021.

Discuss with newspaper Mesdscape Medical News To comment on the findings, Jeffrey Schiff, M.D., Associate Professor, University of Toronto, Ontario, Canada acknowledges that post-transplant diabetes is an important issue.

“We know that in patients who develop diabetes after transplantation there is a very high risk of graft rejection and death, so preventing it is an important goal,” he said in an email. . Schiff further notes that thiazide diuretics have long been associated with a higher prevalence of diabetes in the general population than in other classes of antihypertensives “so finding this among a group of transplant recipients are not surprising,” he commented.

What is surprising, however, is that we see the same effect in these patients taking Loop diuretics who actually have an even higher rate of post-transplant diabetes. This means that loop diuretics affect glucose metabolism in kidney transplant recipients compared with the general population.” Schiff suggested.

Diabetes in diuretics versus no diuretics

In one study, 486 patients at least 1 year post-transplant were enrolled. “Participants were classified into diuretic and non-diuretic users based on their baseline drug use,” the authors note. A total of 388 participants who were non-diuretic users, and 168 participants, representing 35% of the overall cohort, were prescribed diuretics.

At a mean follow-up of about 5.4 years, 11% of the post-transplant patients had developed post-transplant diabetes. However, the incidence of post-transplant diabetes was significantly higher, 18% for diuretic users compared with 7% for non-diuretic users (P<.001), such as Oskooei. reported.

Further analysis revealed that thiazide diuretics and Loop diuretics – the two main diuretics used in patients after kidney transplantation – were associated with an increased risk of diabetes. diabetes mellitus after organ transplantation, but the incidence in the group of Loop diuretics, accounting for 22%, was higher than that of thiazide diuretics, which was 13% (P<.001).

This association was independent of adjustment for potential confounders including lifestyle, use of other medications, renal function, and transplant-specific parameters, the investigators note. , body mass index, lipids and blood pressure”.

Oskooei et al identified various substances in the urinary metabolism of diuretics in the sample cohort “And the results are consistent with our primary analysis of diuretic use as well as for diuretics. thiazide diuretics and Loop diuretics, confirming our main results,” she notes, adding, “Our study is one of the first to evaluate the use of diuretics in kidney transplant patients”.

“But because diuretics are sometimes so important in the treatment of these patients, we need to find individualized risk models and applications to treat each patient,” she reaffirms.

Weighing the risks and benefits of all drugs after a kidney transplant

The discovery of a higher risk of diabetes after transplantation using Loop diuretics compared with thiazide diuretics may have happened by accident, Schiff said, “due to the relative size of the study.” relatively small, so it needs to be confirmed by larger studies,” he noted.

Meanwhile, because many post-transplant patients require diuretics as part of their treatment regimens, transplant nephrologists need to carefully assess the risks and benefits of all medications they prescribe. for any patient to produce the best results with the fewest side effects, he advises.

Further commenting on the study, Matthew Weir, MD, London Health Science Center, Ontario, agrees with Schiff that post-transplant diabetes mellitus is an important although understudied topic. rescue.

“The authors should be congratulated for their work in this area, and their results are thought-provoking,” he said in an email.

However, Weir also said that more work needs to be done to clarify the risk posed by diuretics and tailor that risk to patients who need treatment.

“Volume overload with diuretics has never been considered benign, and it increases the risk of drug-induced diabetes,” Weir emphasizes.

The relationship between diuretics, other transplant drugs, transplant function, and diabetes – which can be full of confounding factors – needs to be explored in further studies.

The study was funded by the European Union 2020. Oskooei reported no conflicts of interest. Schiff has reported on serving on the advisory board for Novartis for the past year.

Source: https://www.medscape.com/viewarticle/953462#vp_1

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Translated by: Thuy Linh