Document Detail


Association of metabolic syndrome with development of new-onset diabetes after transplantation.
MedLine Citation:
PMID:  20724958     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: New-onset diabetes after transplantation (NODAT) is a major posttransplant complication associated with lower allograft and recipient survival. Our objective was to determine whether metabolic syndrome pretransplant is independently associated with NODAT development.
METHODS: We recruited 640 consecutive incident nondiabetic renal transplant recipients from three academic centers between 1999 and 2004. NODAT was defined as the use of hypoglycemic medication, a random plasma glucose level more than 200 mg/dL, or two fasting glucose levels more than or equal to 126 mg/dL beyond 30 days posttransplant.
RESULTS: Metabolic syndrome was common pretransplant (57.2%). NODAT developed in 31.4% of recipients 1 year posttransplant. Participants with metabolic syndrome were more likely to develop NODAT compared with recipients without metabolic syndrome (34.4% vs. 27.4%, P=0.057). Recipients with increasing number of positive metabolic syndrome components were more likely to develop NODAT (metabolic syndrome score prevalence at 1 year: 0 components-0.0%, 1-24.2%, 2-29.3%, 3-31.0%, 4-34.8%, and 5-73.7%, P=0.001). After adjustment for demographics, age by decade (hazard ratio [HR] 1.34 [1.20-1.50], P<0.0001), African American race (HR 1.35 [1.01-1.82], P=0.043), cumulative prednisone dosage (HR 1.18 [1.07-1.30], P=0.001), and metabolic syndrome (HR 1.34 [1.00-1.79], P=0.047) were independent predictors of development of NODAT at 1 year posttransplant. In a multivariable analysis incorporating the individual metabolic syndrome components themselves as covariates, the only pretransplant metabolic syndrome component to remain an independent predictor of NODAT was low high-density lipoprotein (hazard ratio [HR] 1.37 [1.01-1.85], P=0.042).
CONCLUSIONS: Metabolic syndrome is an independent predictor for NODAT and is a possible target for intervention to prevent NODAT. Future studies to evaluate whether modification of metabolic syndrome factors pretransplant reduces NODAT development are needed.
Authors:
Nathaniel D Bayer; Philip T Cochetti; Mysore S Anil Kumar; Valerie Teal; Yonghong Huan; Cataldo Doria; Roy D Bloom; Sylvia E Rosas
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Transplantation     Volume:  90     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-21     Completed Date:  2010-11-16     Revised Date:  2011-10-27    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  861-6     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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MeSH Terms
Descriptor/Qualifier:
Blood Glucose / metabolism
Diabetes Mellitus / epidemiology,  etiology*
Fasting
Female
Humans
Immunosuppressive Agents / therapeutic use
Kidney Transplantation / adverse effects*,  immunology
Male
Metabolic Syndrome X / epidemiology,  etiology*
Middle Aged
Multivariate Analysis
Polycystic Kidney Diseases / epidemiology
Prevalence
Regression Analysis
Tacrolimus / therapeutic use
Grant Support
ID/Acronym/Agency:
K08 DK002626-05/DK/NIDDK NIH HHS; R01 DK080033/DK/NIDDK NIH HHS; R01 DK080033-04/DK/NIDDK NIH HHS; UL1RR024134/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Immunosuppressive Agents; 109581-93-3/Tacrolimus
Comments/Corrections
Comment In:
Transplantation. 2010 Oct 27;90(8):821-2   [PMID:  20686442 ]
Transplantation. 2011 Mar 15;91(5):591-2   [PMID:  21336088 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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