The Association Between Glycemic Control and Clinical Outcomes after Kidney Transplantation

Ramirez, Sofronio C.; Maaske, Jill; Kim, Yoojin; Neagu, Valeriu; DeLange, Susan; Mazhari, Alaleh; Gao, Weihua; Emanuele, Mary Ann; Emanuele, Nicholas V.; Baldwin, David; Mihăilescu, Dan

doi:10.4158/ep13463.or

Cited by 24 publications

(20 citation statements)

References 16 publications

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“…This study’s findings support those observed previously that there is no significant difference between standard blood glucose control (<180 mg/dL) and stricter blood glucose control in terms of graft function or incidence of infections;16,17 however, stricter glucose control is associated with a greater incidence of hypoglycemic events 14,15. Collectively, these results suggest that target glucose levels for diabetic renal transplant patients should be 140–180 mg/dL while hospitalized, rather than stricter control, so that hypoglycemia may be reduced.…”

Section: Discussionsupporting

confidence: 91%

“…There was no statistical difference in graft function between the two treatment groups, although severe hypoglycemia (blood glucose <40 mg/dL) was more common in the intensively treated group (16% of intensively treated patients versus 4% of control patients, p =0.08). In addition, Ramirez et al16 retrospectively evaluated 202 individuals undergoing renal transplant (60% with preexisting diabetes). There was no association between perioperative or chronic glycemic control within the first year of post-renal transplant and graft rejection, infection, or hospital readmission even for those with the tightest glycemic control (80−110 mg/dL).…”

Section: Discussionmentioning

confidence: 99%

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Role of glycemic control on hospital-related outcomes in patients with diabetes mellitus undergoing renal transplantation

Lamos

Wijesinha

Ramhmdani

et al. 2017

DMSO

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ObjectiveTo compare length of stay (LOS) and incidence of hypoglycemic events and infections in hospitalized patients with diabetes mellitus (DM) undergoing renal transplantation, among groups of patients defined by admission glucose and mean inpatient daily glucose.MethodsA retrospective analysis of 190 charts of patients with DM who underwent renal transplantation over a 2-year period was conducted. Patients were grouped according to admission glucose and mean inpatient daily glucose (≤140 mg/dL, 141–180 mg/dL, and >180 mg/dL).ResultsAdmission glucose was not associated with LOS. A mean inpatient daily glucose of ≤140 mg/dL was associated with a longer LOS compared to a mean inpatient daily glucose of >180 mg/dL (p=0.03). Patients with an admission glucose of ≤140 mg/dL had approximately half the rate of hypoglycemic events compared to those with admission glucose of 141−180 mg/dL (odds ratio [OR]=2.1; p=0.02) or >180 mg/dL (OR=1.9; p=0.04). However, patients whose mean daily glucose was ≤140 mg/dL had approximately twice the rate of hypoglycemic events than those whose mean daily glucose was 141−180 mg/dL (OR=0.4; p=0.01) or >180 mg/dL (OR=0.4; p=0.004). The incidence of infections was low and was not associated with admission or mean daily glucose levels.ConclusionLower mean daily inpatient glucose levels (≤140 mg/dL) are associated with longer LOS and greater incidence of hypoglycemic episodes in diabetes patients undergoing renal transplantation. Our findings suggest that target blood glucose levels of 140−180 mg/dL may be appropriate in this specific population. Additional prospective research is needed to confirm these findings.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Role of glycemic control on hospital-related outcomes in patients with diabetes mellitus undergoing renal transplantation

Lamos

Wijesinha

Ramhmdani

et al. 2017

DMSO

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“…We found that postoperative daily fasting or peak BG was unrelated to infection arising during transplant admission, which is in keeping with prior studies which did not show a relationship between mean BG during transplant admission and infection by 30 days [13] or by 12 months [14]. The increased risk of infection seen only in those with DM may relate to other factors such as prior glycaemic control, the chronic inflammatory milieu of DM, or obesity.…”

Section: Discussionsupporting

confidence: 90%

The Effect of Different Glycaemic States on Renal Transplant Outcomes

Sheu

Depczynski

O’Sullivan

et al. 2016

Journal of Diabetes Research

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Background. Optimal glycaemic targets following transplantation are unknown. Understanding the impact of DM and posttransplant diabetes mellitus (PTDM) may improve patient and graft survival in transplant recipients. Aim. To determine the perioperative and one-year outcomes after renal transplantation and whether these outcomes are affected by preexisting DM, PTDM, or glycaemia during transplant admission. Method. Adult recipients of renal transplants from a single centre over 5.5 years were retrospectively reviewed. Measured outcomes during transplant admission included glycaemia and complications (infective complications, acute rejection, and return to dialysis) and, at 12 months, glycaemic control and complications (cardiovascular complication, graft failure). Results. Of 148 patients analysed, 29 (19.6%) had DM and 27 (18.2%) developed PTDM. Following transplantation, glucose levels were higher in patients with DM and PTDM. DM patients had a longer hospital stay, had more infections, and were more likely return to dialysis. PTDM patients had increased rates of acute rejection and return to dialysis. At 1 year after transplant, there were more cardiovascular complications in DM patients compared to those without DM. Conclusions. Compared to patients without DM, patients with DM or PTDM are more likely to suffer from complications perioperatively and at 12 months. Perioperative glycaemia is associated with graft function and may be a modifiable risk.

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“…Another term, "posttransplantation diabetes mellitus" (PTDM) (97,98), describes the presence of diabetes in the posttransplant setting irrespective of the timing of diabetes onset. Hyperglycemia is very common during the early posttransplant period, with ;90% of kidney allograft recipients exhibiting hyperglycemia in the first few weeks following transplant (97)(98)(99)(100). In most cases, such stress-or steroidinduced hyperglycemia resolves by the time of discharge (100,101).…”

Section: Posttransplantation Diabetes Mellitusmentioning

confidence: 99%

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

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1,223

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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The Association Between Glycemic Control and Clinical Outcomes after Kidney Transplantation

Cited by 24 publications

References 16 publications

Role of glycemic control on hospital-related outcomes in patients with diabetes mellitus undergoing renal transplantation

Role of glycemic control on hospital-related outcomes in patients with diabetes mellitus undergoing renal transplantation

The Effect of Different Glycaemic States on Renal Transplant Outcomes

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2018

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