Effect of Calcineurin Inhibitor on Blood Glucose Level in Non-Diabetic Kidney Transplant Patients

  • A Aditiawardana Universitas Airlangga
  • Fauzia N Liani Universitas Airlangga
  • Chandra Irwanadi Universitas Airlangga
  • Nunuk Mardiana Universitas Airlangga
  • P Pranawa Universitas Airlangga

Abstract

Background Calcineurin inhibitor (CNI) is a class of immunosuppressant agent used in kidney transplant management, known to pose risk for new-onset diabe­tes after transplant (NODAT). Tacrolimus and cyclo­sporine cause NODAT through multiple mechanisms, such as decreasing insulin secretion, increasing in­sulin resistance, and a direct effect on the pancreatic beta cell. Method This is a retrospective study on pa­tients receiving immunosuppressant agents for kidney transplant patients in Surabaya. The immunosuppres­sant agents studied were CNI (tacrolimus and cyclo­sporine) in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroid. The blood glucose measured were fasting blood glucose (FBD) and 2-hour postprandial blood glucose (2PPBG). Ob­jective Aim of this study is to determine the effect of calcineurin inhibitor (CNI) on glucose regulation in the nondiabetic renal transplant patient. Result Fifty-six subjects were included in the study, divided into two groups. One group of 28 patients (50%) received tac­rolimus-MMF-MP and the other group received cyc­losporine-MMF-MP. A significant increase in fasting blood glucose (pre-intervention level 86 ± 6 mg/dl vs post-intervention level 109 ± 34 mg/dl with p = 0.01) and 2-hour postprandial blood glucose (pre-interven­tion level 117 ± 20 mg/dl vs post-intervention level 150 ± 43 mg/dl with p < 0.001) was found in the tacro­limus group. A significant increase was also found in the cyclosporine group, both in fasting blood glucose (pre-intervention value 85 ± 7 mg/dl vs post-interven­tion value 97 ± 22 mg/dl with p = 0.002) and 2-hour postprandial blood glucose (pre-intervention value 119 ± 18 mg/dl vs post-intervention value 148 ± 55 mg/dl with p = 0.001). Tacrolimus was found to have a relative risk of NODAT up to 1.2 fold compared to cy­closporine. Conclusion Tacrolimus poses 1.29 relative risk of NODAT compared to cyclosporine. However, both drugs significantly increase fasting blood glucose and 2-hour postprandial blood glucose in non-diabetic patients receiving kidney transplantation.

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Author Biographies

A Aditiawardana, Universitas Airlangga

Nephrology Division, Internal Medicine Department, RSUD Dr. Soetomo, Universitas Airlangga, Surabaya, Indonesia

Fauzia N Liani, Universitas Airlangga

Nephrology Division, Internal Medicine Department, RSUD Dr. Soetomo, Universitas Airlangga, Surabaya, Indonesia

Chandra Irwanadi, Universitas Airlangga

Nephrology Division, Internal Medicine Department, RSUD Dr. Soetomo, Universitas Airlangga, Surabaya, Indonesia

Nunuk Mardiana, Universitas Airlangga

Nephrology Division, Internal Medicine Department, RSUD Dr. Soetomo, Universitas Airlangga, Surabaya, Indonesia

P Pranawa, Universitas Airlangga

Nephrology Division, Internal Medicine Department, RSUD Dr. Soetomo, Universitas Airlangga, Surabaya, Indonesia

Published
2018-10-18
How to Cite
1.
Aditiawardana A, Liani F, Irwanadi C, Mardiana N, Pranawa P. Effect of Calcineurin Inhibitor on Blood Glucose Level in Non-Diabetic Kidney Transplant Patients. inakidney [Internet]. 18Oct.2018 [cited 31Mar.2020];1(1). Available from: http://inakidneyhypertension.co.id/index.php/inakidney/article/view/7
Section
Original Articles