title: Cardiovascular consequences of new-onset hyperglycemia after kidney transplantation.
abstract: BACKGROUND
  New-onset diabetes after transplantation (NODAT) is associated with high cardiovascular (CV) risk and reduced patient survival. It is unclear whether this risk is newly acquired or represents preexisting CV disease in patients with this complication.
  
  
  METHODS
  Included are 1146 adults, recipients of first kidney transplants from 1984 to 2008 treated with modern immunosuppressants.
  
  
  RESULTS
  One year after transplantation, 29.8% of patients experienced impaired fasting glycemia and 13.4% NODAT. The risk of NODAT related to recipient variables include the following: older age, male gender, higher body mass index, higher pretransplantation glucose and triglyceride levels, and lower high-density lipoprotein level. Increasing fasting glucose levels at 1, 4, or 12 months after transplantation, independent of other factors, related to reduced patient survival (12 months hazard ratio [HR]=1.146 [1.132-1.161], P<0.0001 for 10mg/dL increase in glucose), and this was primarily because of an increase in CV deaths. Hyperglycemia related to all major CV events (MCVE), cardiac (HR=1.113 [1.094-1.132], P<0.0001), vascular (HR=1.168 [1.140-1.197], P<0.0001), and strokes (HR=1.156 [1.123-1.191], P=0.003). These relations were statistically independent of other risk factors. The increased risk of MCVE was noted particularly in patients without MCVE before transplantation (HR=1.145 [1.126-1.165], P<0.0001). Furthermore, among patients with after transplantation MCVE (n=123, 11%), hyperglycemia increases the risk of death (NODAT: HR=2.410 [1.125-5.162], P=0.024).
  
  
  CONCLUSIONS
  After transplantation hyperglycemia is a strong independent risk factor for MCVE and death, mainly from CV causes. This risk is independent of the presence of CV disease identified before transplantation.
authors: Visiting Medical Student, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
authors: Rianne P
authors: RP
authors: Wauters
authors: Fernando G
authors: FG
authors: Cosio
authors: Maria L
authors: ML
authors: Suarez Fernandez
authors: Yogish
authors: Y
authors: Kudva
authors: Pankaj
authors: P
authors: Shah
authors: Vicente E
authors: VE
authors: Torres
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D001786:Blood Glucose