Relationship between Inpatient Hyperglycemia and Insulin Treatment after Kidney Transplantation and Future New Onset Diabetes Mellitus

Chakkera, Harini A.; Knowler, William C.; Devarapalli, Y.; Weil, E. Jennifer; Heilman, Raymond L.; Dueck, Amylou C.; Mulligan, David C.; Reddy, Kunam S.; Moss, Adyr; Mekeel, Kristin L.; Mazur, Marek; Hamawi, K.; Castro, Janna C.; Cook, Curtiss B.

doi:10.2215/cjn.09481209

Cited by 92 publications

(103 citation statements)

References 23 publications

(14 reference statements)

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“…Perioperative hyperglycemia is also associated with NODAT [21][22][23] . Hyperglycemia is caused by stress reaction to surgery (catecholamines), corticosteroids and restoration of renal function.…”

Section: Perioperative Hyperglycemiamentioning

confidence: 99%

“…In their study, Chakkera et al showed that among 377 patients who developed hyperglycemia during their transplantation hospitalization, 29% (ref. 21 ) developed NODAT within the first year after transplantation. NODAT developed in just 4% (ref.…”

Section: Perioperative Hyperglycemiamentioning

confidence: 99%

“…NODAT developed in just 4% (ref. 21 ) patients without inpatient hyperglycemia. Post-transplant inpatient hyperglycemia was defined as any bedside capillary blood glucose over 11.1 mmol/L.…”

Section: Perioperative Hyperglycemiamentioning

confidence: 99%

“…miRNAs are endogenously produced short noncording RNAs of [19][20][21][22][23] nucleotides that play an important role in modulating gene expression affecting almost every key cellular function 41 . They can bind to the 3` untranslated region of miRNA of protein-coding genes to down-regulate their expression 42 .…”

Section: Future Perspective Of Nodatmentioning

confidence: 99%

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New-onset diabetes mellitus after renal transplantation

Goldmannová¹,

Karásek²,

Krystynik³

et al. 2016

BIOMED PAP

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Background and Aim. Diabetes mellitus is a very common metabolic disease with a rising incidence. It is both a leading cause of chronic renal disease and one of the most serious comorbidities in renal transplant recipients. New-onset diabetes after renal transplantation (NODAT) is associated with poor graft function, higher rates of cardiovascular complications and a poor prognosis. The aim of this paper is to review current knowledge of NODAT including risk factors, diagnosis and management. Methods. A MEDLINE search was performed to retrieve both original and review articles addressing the epidemiology, risk factors, screening and management of NODAT. We also focused on microRNAs as potential biomarkers of NODAT. Results and Conclusion. Understanding the risk factors (both modifiable-e.g. obesity, viruses, and unmodifiable-e.g. age, genetics) may help reduce the incidence and impact of NODAT using pre-and post-transplant management. This can lead to better long-term graft function and general transplant success.

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Section: Perioperative Hyperglycemiamentioning

confidence: 99%

Section: Perioperative Hyperglycemiamentioning

confidence: 99%

Section: Perioperative Hyperglycemiamentioning

confidence: 99%

Section: Future Perspective Of Nodatmentioning

confidence: 99%

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New-onset diabetes mellitus after renal transplantation

Goldmannová¹,

Karásek²,

Krystynik³

et al. 2016

BIOMED PAP

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“…2,4 New-onset diabetes after transplantation (NODAT) is a common and serious disorder that curtails recipient survival. [5][6][7] NODAT is associated with cardiovascular complications [8][9][10][11] and develops in 2%-50% 12 of renal transplant recipients. Approximately 50% of recipients with NODAT require insulin therapy.…”

mentioning

confidence: 99%

Genetics of New-Onset Diabetes after Transplantation

McCaughan

McKnight²,

Maxwell

2014

Journal of the American Society of Nephrology

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New-onset diabetes after transplantation is a common complication that reduces recipient survival. Research in renal transplant recipients has suggested that pancreatic b-cell dysfunction, as opposed to insulin resistance, may be the key pathologic process. In this study, clinical and genetic factors associated with new-onset diabetes after transplantation were identified in a white population. A joint analysis approach, with an initial genome-wide association study in a subset of cases followed by de novo genotyping in the complete case cohort, was implemented to identify single-nucleotide polymorphisms (SNPs) associated with the development of new-onset diabetes after transplantation. Clinical variables associated with the development of diabetes after renal transplantation included older recipient age, female sex, and percentage weight gain within 12 months of transplantation. The genome-wide association study identified 26 SNPs associated with new-onset diabetes after transplantation; this association was validated for eight SNPs (rs10484821, rs7533125, rs2861484, rs11580170, rs2020902, rs1836882, rs198372, and rs4394754) by de novo genotyping. These associations remained significant after multivariate adjustment for clinical variables. Seven of these SNPs are associated with genes implicated in b-cell apoptosis. These results corroborate recent clinical evidence implicating b-cell dysfunction in the pathophysiology of newonset diabetes after transplantation and support the pursuit of therapeutic strategies to protect b cells in the post-transplant period. One-year graft survival after renal transplantation is now excellent, exceeding 93% for organs donated after brain death and 96% for those from living donors. 1-3 Technical advancements in surgery, improved understanding of immunology, and innovative developments in pharmacology have altered the landscape of renal transplantation. The goal of preventing early graft loss has largely been achieved and arguably the greatest challenge now is the avoidance of late graft failure. Although there has been a considerable improvement in 1-year renal transplant survival, the rate of graft attrition after the first year remains frustratingly constant. 2,4 New-onset diabetes after transplantation (NODAT) is a common and serious disorder that curtails recipient survival. [5][6][7] NODAT is associated with cardiovascular complications [8][9][10][11] and develops in 2%-50% 12 of renal transplant recipients. Approximately 50% of recipients with NODAT require insulin therapy. [6][7][8][13][14][15] A number of clinical variables have been associated with NODAT, including black ethnicity, older recipient age, female sex, obesity, immunosuppression, and viral infections. 5,6,8,13,16,17 Until recently, the pathophysiology of NODAT was considered to be analogous to type 2 diabetes mellitus. Renal transplant recipients have increased insulin resistance compared with transplant-naïve persons with normal renal function. 18 In a nondiabetic renal transplant population, the m...

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