Document Detail


Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus.
MedLine Citation:
PMID:  20558559     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Approximately two-thirds of kidney transplant recipients with no previous history of diabetes experience inpatient hyperglycemia immediately after kidney transplant surgery; whether inpatient hyperglycemia predicts future new onset diabetes after transplant (NODAT) is not established.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective study was conducted to determine the risk conferred by inpatient hyperglycemia on development of NODAT within 1 year posttransplant. All adult nondiabetic kidney transplant recipients between June 1999 and January 2008 were included. Posttransplant inpatient hyperglycemia was defined as any bedside capillary blood glucose > or = 200 mg/dl or insulin therapy during hospitalization. NODAT was defined as HbA1C > or = 6.5%, fasting venous serum glucose > or = 126 mg/dl, or prescribed diet or medical therapy for diabetes mellitus.
RESULTS: The study cohort included 377 patients. NODAT developed in 1 (4%) of the 28 patients without inpatient hyperglycemia, 4 (18%) of the 22 patients with inpatient hyperglycemia but not treated with insulin, and in 98 (30%) of the 327 of the patients who were diagnosed with inpatient hyperglycemia and were treated with insulin. In adjusted analyses, requirement of insulin therapy during hospitalization posttransplant was associated with a 4-fold increase in NODAT (relative risk 4.01; confidence interval, 1.49 to 10.7; P = 0.006).
CONCLUSION: Development of inpatient hyperglycemia after kidney transplantation in nondiabetic patients significantly increased the risk of NODAT. Additionally, we observed a significantly increased risk of cardiovascular events in patients who developed NODAT.
Authors:
Harini A Chakkera; William C Knowler; Yugandhara Devarapalli; E Jennifer Weil; Raymond L Heilman; Amylou Dueck; David C Mulligan; Kunam S Reddy; Adyr A Moss; Kristin L Mekeel; Marek J Mazur; Khaled Hamawi; Janna C Castro; Curtiss B Cook
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-06-17
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  5     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-08     Completed Date:  2011-01-11     Revised Date:  2011-09-13    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1669-75     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA. chakkera.harini@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Arizona
Biological Markers / blood
Blood Glucose / metabolism
Cardiovascular Diseases / etiology
Chi-Square Distribution
Diabetes Mellitus / blood,  etiology*,  therapy
Female
Hemoglobin A, Glycosylated / metabolism
Humans
Hyperglycemia / blood,  drug therapy*,  etiology*
Hypoglycemic Agents / therapeutic use*
Inpatients*
Insulin / therapeutic use*
Kidney Transplantation / adverse effects*
Logistic Models
Male
Middle Aged
Risk Assessment
Risk Factors
Time Factors
Grant Support
ID/Acronym/Agency:
1 KL2 RR024151/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Blood Glucose; 0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents; 0/hemoglobin A1c protein, human; 11061-68-0/Insulin
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