Glucose control is associated with patient survival in diabetic patients after renal transplantation.
BACKGROUND
The efficacy of tight glycemic control for the prevention of death and renal failure in the general diabetic population is well established. However, in diabetic renal-allograft recipients, the effect of different treatment strategies on outcomes is undetermined.


METHODS
We conducted a cohort study of 798 diabetic, renal-allograft recipients transplanted at the Medical University of Vienna between 1990 and 2004. We studied the influence of glucose parameters and diabetes treatment on mortality and graft loss. Marginal-structural models and multivariable Cox regression analysis were used to control for confounding.


RESULTS
Maximal glucose levels but not HbA1c were independently associated with mortality. Being in the highest quartile of maximal glucose increased the adjusted risk of death by a factor of 2.2 (P value for trend 0.009). Furthermore, in patients receiving insulin, the risk of death was increased 1.7-fold (95% confidence interval 0.9-3.1) compared with diet and 2.0-fold (95% confidence interval 1.1-3.7) compared with oral medication. Maximal glucose, HbA1c, or diabetes treatment did not influence death-censored functional graft survival.


CONCLUSIONS
In conclusion, maximal glucose levels and insulin treatment were independently associated with higher rates of mortality in our cohort of diabetic, renal-allograft recipients. However, graft survival was unaffected.
Wiesbauer
Franz
F
Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Heinze
Georg
G
Regele
Heinz
H
Hörl
Walter H
WH
Schernthaner
Gerit H
GH
Schwarz
Christoph
C
Kainz
Alexander
A
Kramar
Reinhard
R
Oberbauer
Rainer
R
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000601:surgery*; D005060:Europe; D006442:Glycated Hemoglobin / Q000378:metabolism; D006085:Graft Survival / Q000502:physiology; D006706:Homeostasis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin