Netherlands: Study on Diuretics and PTDM in Kidney Transplant Recipients

A recent study showed that overall, diuretics are associated with an increased risk of developing post-transplantation diabetes mellitus (PTDM) in kidney transplant recipients (KTRs). The association was seen both for thiazide and loop diuretics. The study was published in the journal Nephrology Dialysis Transplantation on 29 January 2022.

PTDM is seen as a major clinical problem in recipients of kidney transplants. Diuretic-induced hyperglycemia and diabetes is shown to be prevalent in the general population. Sara Sokooti, University of Groningen, Groningen, The Netherlands, and colleagues therefore aimed to investigate if diuretics also increase PTDM risk in KTRs.

For this purpose, the researchers included 486 stable outpatient KTRs (with a functioning graft ≥ 1 year) without diabetes from a prospective cohort study. Based on their medication use verified by medical records, the participants were classified as diuretic users and non-users.

Study Findings

• At current baseline study, 168 (35%) KTRs used a diuretic (thiazide, n = 74; loop diuretic, n = 76; others, n = 18) and 318 KTRs did not use a diuretic.
• After 5.2 years of follow up, 54 (11%) KTRs developed PTDM.
• In Cox regression analyses, diuretic use was associated with incident PTDM, independent of age, sex, fasting plasma glucose (FPG), and HbA1c (hazard ratio [HR] 3.28).
• Further adjustment for potential confounders, including lifestyle, family history of cardiovascular disease, use of other medication, kidney function, transplantation-specific parameters, BMI, lipids, and blood pressure did not materially change the association.
• In Cox regression analyses, both thiazide and loop diuretics associated with the development of PTDM, independent of age, sex, FPG, and HbA1c ([HR 2.70], and [HR 5.08], respectively).

To conclude, the study showed overall, diuretics are associated with increased risk of developing PTDM in KTRs, independent of established risk factors for the development of PTDM. The association was present both for thiazide and loop diuretics.

Reference

Sara Sokooti, Frank Klont, Sok Cin Tye, Daan Kremer, Rianne M Douwes, Gérard Hopfgartner, Robin P F Dullaart, Hiddo J L Heerspink, Stephan J L Bakker, Association of diuretic use with increased risk for long-term post-transplantation diabetes mellitus in kidney transplant recipients, Nephrology Dialysis Transplantation, 2022;, gfac012, https://doi.org/10.1093/ndt/gfac012