Discussion
PCKD, CKD, anxiety, PTDM, KTR, sarcopenia, anemia, pain, neuropathic, depressive, muscular weakness, Metabolic dysfunction, metabolic dysfunction, hypoglycemic, hypoglycemic complications, cysts, diabetes
INFLAMMATION, DISEASE, SARCOPENIA, GENETIC DISORDER, PATHOPHYSIOLOGY, ANEMIA, SYNDROMES, COMPLICATIONS, DIABETES
In this analysis of data from a randomized controlled trial [The risk of hypoglycemic complications in PTDM patients was found to be comparable to other types of DM [A possible explanation for why early basal insulin therapy does not affect HRQOL in KT recipients despite having similar diabetes and hypoglycemic associated complications may be a stronger positive effect of KT itself [To further explore the effects of early postoperative insulin therapy on HRQOL, we resampled the study participants according to their risk of developing PTDM using the factors age and clinical predisposition for metabolic dysfunction in addition to laboratory markers. Metabolic dysfunction may be the result of an unfavorable lifestyle or a genetic predisposition including a positive family history of DM. In line, PCKD as a systemic genetic disorder resulting in a progressive growth of cysts not only in the kidneys, but also in the liver, seminal ducts, and/or pancreas are at high-risk to develop PTDM [The cause of muscular weakness in KTR is multifactorial. Older patients experience geriatric syndromes like sarcopenia, which itself, has a complex pathophysiology including reduced physical activity, systemic inflammation, and neuropathic changes leading to a denervation of muscles [The high-risk group also had a greater disease specific symptom burden, pain, and impaired emotional-role-functioning 24 months after KT compared to the low-risk PTDM group, with comparable values between groups at 6 and 12 months, suggesting again a slowly vanishing effect of KT on HRQOL in the high-risk PTDM group. We also found a statistical association of renal function (eGFR) and hemoglobin levels to the HRQOL 24 months after KT independent from early insulin treatment and PTDM-risk in the multivariable analysis. Hemoglobin levels were associated with the physical health domain (PCS score), while renal function was related to the mental health domain (MCS score) of the SF-36. The symptom burden of KTRs influencing HRQOL is multifactorial including decreased renal function, anemia, depressive symptoms, anxiety, and elevated BMI, as well as treatment-specific encompassing side effects and complications of immunosuppressive therapy [Our study has certain limitations including a considerable proportion of missing data within the HRQOL questionnaires, especially towards the end of the study period which might lead to underestimation to detect lower effect sizes. This is mainly explained by patients lost to follow-up or incompliance with completing the questionnaires. Furthermore, this analysis lacks socioeconomic data as well as comparison of different ethnicities since Caucasians were in the majority included in the ITP-NODAT study [Taken together, early postoperative insulin therapy, which might be reasonable in selected patient groups, is not compromising the HRQOL. Although KT substantially improves the HRQOL of CKD patients 1 year after transplantation, patients in the high-risk PTDM group experience a significant impairment in HRQOL in the long course after KT. The HRQOL of KTR is significantly dependent on graft function and anemia. Given the complex relationship between manageable risk factors, physical and psychological symptom burden, and nephrological treatment, a multidisciplinary post-transplant care should be considered to meet the multidimensional needs of KTR, especially within high-risk PTDM populations.