TY - JOUR
T1 - Association of pretransplant glycemic controlwith posttransplant outcomes in diabetic kidney transplant recipients
AU - Molnar, Miklos Z.
AU - Huang, Edmund
AU - Hoshino, Junichi
AU - Krishnan, Mahesh
AU - Nissenson, Allen R.
AU - Kovesdy, Csaba P.
AU - Kalantar-Zadeh, Kamyar
PY - 2011/12
Y1 - 2011/12
N2 - OBJECTIVE - Observational studies have yielded inconsistent findings regarding the association of hemoglobin A 1c (HbA 1c) with survival in diabetic patients on dialysis. The association between pretransplant glycemic control and short- and long-term posttransplant outcomes in kidney transplant recipients is not clear. RESEARCH DESIGN AND METHOD - Linking the 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, we identified 2,872 diabetic dialysis patients who underwent first kidney transplantation. Mortality or graft failure and delayed graft function (DGF) risks were estimated by Cox regression (hazard ratio [HR]) and logistic regression (odds ratio), respectively. RESULT - Patients were 53 ± 11 years old and included 36% women and 24% African Americans. In our fully adjusted model, allograft failure-censored, all-cause death HR and 95% CI for time-averaged pretransplant HbA 1c categories of 7 to <8%, 8 to <9%, 9 to 10%, and ≥10%, compared with 6 to <7% (reference), were 0.89 (0.59-1.36), 2.06 (1.31-3.24), 1.41 (0.73-2.74), and 3.43 (1.56-7.56), respectively; and graft failure-censored cardiovascular death HR was 0.38 (0.13-1.05), 1.78 (0.69-4.55), 1.59 (0.44-5.76), and 4.28 (0.85-21.64), respectively. We did not find any difference in risk of death-censored graft failure or DGF with different pretransplant HbA 1c levels. CONCLUSION - Poor pretransplant glycemic control appears associated with decreased posttransplant survival in kidney transplant recipients, whereas allograft outcomes may not be affected.
AB - OBJECTIVE - Observational studies have yielded inconsistent findings regarding the association of hemoglobin A 1c (HbA 1c) with survival in diabetic patients on dialysis. The association between pretransplant glycemic control and short- and long-term posttransplant outcomes in kidney transplant recipients is not clear. RESEARCH DESIGN AND METHOD - Linking the 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, we identified 2,872 diabetic dialysis patients who underwent first kidney transplantation. Mortality or graft failure and delayed graft function (DGF) risks were estimated by Cox regression (hazard ratio [HR]) and logistic regression (odds ratio), respectively. RESULT - Patients were 53 ± 11 years old and included 36% women and 24% African Americans. In our fully adjusted model, allograft failure-censored, all-cause death HR and 95% CI for time-averaged pretransplant HbA 1c categories of 7 to <8%, 8 to <9%, 9 to 10%, and ≥10%, compared with 6 to <7% (reference), were 0.89 (0.59-1.36), 2.06 (1.31-3.24), 1.41 (0.73-2.74), and 3.43 (1.56-7.56), respectively; and graft failure-censored cardiovascular death HR was 0.38 (0.13-1.05), 1.78 (0.69-4.55), 1.59 (0.44-5.76), and 4.28 (0.85-21.64), respectively. We did not find any difference in risk of death-censored graft failure or DGF with different pretransplant HbA 1c levels. CONCLUSION - Poor pretransplant glycemic control appears associated with decreased posttransplant survival in kidney transplant recipients, whereas allograft outcomes may not be affected.
UR - http://www.scopus.com/inward/record.url?scp=84857791539&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84857791539&partnerID=8YFLogxK
U2 - 10.2337/dc11-0906
DO - 10.2337/dc11-0906
M3 - Article
C2 - 21994430
AN - SCOPUS:84857791539
SN - 0149-5992
VL - 34
SP - 2536
EP - 2541
JO - Diabetes care
JF - Diabetes care
IS - 12
ER -