Association of pretransplant glycemic controlwith posttransplant outcomes in diabetic kidney transplant recipients

Miklos Z. Molnar, Edmund Huang, Junichi Hoshino, Mahesh Krishnan, Allen R. Nissenson, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)2536-2541
Number of pages6
JournalDiabetes Care
Volume34
Issue number12
DOIs
StatePublished - Dec 1 2011
Externally publishedYes

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Hemoglobin A
Delayed Graft Function
Kidney
Dialysis
Transplants
Allografts
Survival
African Americans
Kidney Transplantation
Observational Studies
Registries
Cause of Death
Research Design
Logistic Models
Odds Ratio
Organizations
Mortality
Transplant Recipients

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Molnar, M. Z., Huang, E., Hoshino, J., Krishnan, M., Nissenson, A. R., Kovesdy, C., & Kalantar-Zadeh, K. (2011). Association of pretransplant glycemic controlwith posttransplant outcomes in diabetic kidney transplant recipients. Diabetes Care, 34(12), 2536-2541. https://doi.org/10.2337/dc11-0906

Association of pretransplant glycemic controlwith posttransplant outcomes in diabetic kidney transplant recipients. / Molnar, Miklos Z.; Huang, Edmund; Hoshino, Junichi; Krishnan, Mahesh; Nissenson, Allen R.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Diabetes Care, Vol. 34, No. 12, 01.12.2011, p. 2536-2541.

Research output: Contribution to journalArticle

Molnar, MZ, Huang, E, Hoshino, J, Krishnan, M, Nissenson, AR, Kovesdy, C & Kalantar-Zadeh, K 2011, 'Association of pretransplant glycemic controlwith posttransplant outcomes in diabetic kidney transplant recipients', Diabetes Care, vol. 34, no. 12, pp. 2536-2541. https://doi.org/10.2337/dc11-0906
Molnar, Miklos Z. ; Huang, Edmund ; Hoshino, Junichi ; Krishnan, Mahesh ; Nissenson, Allen R. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Association of pretransplant glycemic controlwith posttransplant outcomes in diabetic kidney transplant recipients. In: Diabetes Care. 2011 ; Vol. 34, No. 12. pp. 2536-2541.
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abstract = "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.",
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