The impact of early-diagnosed new-onset post-transplantation diabetes mellitus on survival and major cardiac events.
The impact of early-diagnosed new-onset post-transplantation diabetes mellitus (PTDM) on cardiovascular (CV) disease is not well described. The objectives of the present prospective single-center observational study were to assess the long-term effects of early-diagnosed new-onset PTDM on major cardiac events (MCE; cardiac death or nonfatal acute myocardial infarction) and patient survival. Diabetic status and CV risk factors were assessed in 201 consecutive renal allograft recipients 3 months after transplantation (baseline) during a period of 16 months (1995-96). Follow-up data until January 1, 2004 were obtained from the Norwegian Renal Registry. The 8-year (range 7-9 years) cumulative incidence of MCEs was 7% (nine out of 138) in recipients without diabetes, 20% (seven out of 35) in patients with new-onset PTDM and 21% (six out of 28) in patients with diabetes mellitus before transplantation (DM). Proportional hazards regression analyses (forward stepwise regression) revealed that patients with PTDM had an approximately three-fold increased risk of MCEs as compared with nondiabetic patients (hazard ratio (HR)=3.27, 95% confidence interval (CI)=1.22-8.80, P=0.019). A total of 61 patients (30%) died. Eight-year patient survival was 80% in the nondiabetic group, 63% in the PTDM group and 29% in the DM group, respectively. Pretransplant diabetes (HR=5.09, 95% CI=2.60-9.96, P<0.001), age (HR=1.03, 95% CI=1.01-1.05, P=0.016), cytomegalovirus (CMV) infection (HR=2.66, 95% CI=1.27-5.53, P=0.009), and creatinine clearance (HR=0.98, 95% CI=0.96-1.00, P=0.046), but not PTDM (HR=1.20, 95% CI=0.58-2.49, P=0.621), were independent predictors of death in the multiple Cox regression model. Early-diagnosed PTDM is a predictor of MCEs, but not of all-cause mortality, the first 8 years after renal transplantation.
Hjelmesaeth
J
J
Department of Medicine, Rikshospitalet University Hospital, Oslo, Norway. joran@online.no
Hartmann
A
A
Leivestad
T
T
Holdaas
H
H
Sagedal
S
S
Olstad
M
M
Jenssen
T
T
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002423:Cause of Death; D003404:Creatinine / Q000652:urine; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D050171:Dyslipidemias / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D016030:Kidney Transplantation / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous
D002097:C-Reactive Protein; D003404:Creatinine