Journal Article

Characterization of Remitting and Relapsing Hyperglycemia in Post-Renal-Transplant Recipients

Chakkera, Harini A., Cook, Curtiss B., Saghafian, Soroush, Boloori, Alireza

2015

Overview

Hyperglycemia following solid organ transplant is common among patients without pre-existing diabetes mellitus (DM). Post-transplant hyperglycemia can occur once or multiple times, which if continued, causes new-onset diabetes after transplantation (NODAT). To study if the first and recurrent incidence of hyperglycemia are affected differently by immunosuppressive regimens, demographic and medical-related risk factors, and inpatient hyperglycemic conditions (i.e., an emphasis on the time course of post-transplant complications). We conducted a retrospective analysis of 407 patients who underwent kidney transplantation at Mayo Clinic Arizona. Among these, there were 292 patients with no signs of DM prior to transplant. For this category of patients, we evaluated the impact of (1) immunosuppressive drugs (e.g., tacrolimus, sirolimus, and steroid), (2) demographic and medical-related risk factors, and (3) inpatient hyperglycemic conditions on the first and recurrent incidence of hyperglycemia in one year post-transplant. We employed two versions of Cox regression analyses: (1) a time-dependent model to analyze the recurrent cases of hyperglycemia and (2) a time-independent model to analyze the first incidence of hyperglycemia. Age (P = 0.018), HDL cholesterol (P = 0.010), and the average trough level of tacrolimus (P<0.0001) are significant risk factors associated with the first incidence of hyperglycemia, while age (P<0.0001), non-White race (P = 0.002), BMI (P = 0.002), HDL cholesterol (P = 0.003), uric acid (P = 0.012), and using steroid (P = 0.007) are the significant risk factors for the recurrent cases of hyperglycemia. This study draws attention to the importance of analyzing the risk factors associated with a disease (specially a chronic one) with respect to both its first and recurrent incidence, as well as carefully differentiating these two perspectives: a fact that is currently overlooked in the literature.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Body mass / Cancer therapies / Cholesterol / Cohort Studies / Complications / Demographics / Development and progression / Diabetes / Diabetes mellitus / Drugs / Encyclopedias / Endocrinology / Fasting / Female / Health aspects / Health risk assessment / Health risks / High density lipoprotein / Humans / Hyperglycemia / Hyperglycemia - complications / Hyperglycemia - drug therapy / Hyperglycemia - epidemiology / Immune response regulation / Immunosuppressive agents / Immunosuppressive Agents - therapeutic use / Incidence / Kidney Transplantation / Male / Middle Aged / Nephrology / Patient outcomes / Patients / Rapamycin / Recurrence / Regression analysis / Risk analysis / Risk Factors / Sirolimus - therapeutic use / Steroids / Steroids - therapeutic use / Studies / Tacrolimus / Tacrolimus - therapeutic use / Transplant Recipients / Transplantation / Transplants & implants / Uric acid