Cardiovascular consequences of new-onset hyperglycemia after kidney transplantation

Rianne P. Wauters, Fernando G Cosio, Maria L. Suarez Fernandez, Yogish C Kudva, Pankaj Shah, Vicente Torres

Research output: Contribution to journalArticle

43 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)377-382
Number of pages6
JournalTransplantation
Volume94
Issue number4
DOIs
StatePublished - Aug 27 2012

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Hyperglycemia
Kidney Transplantation
Transplantation
Glucose
Fasting
Cardiovascular Diseases
Preexisting Condition Coverage
Survival
HDL Lipoproteins
Immunosuppressive Agents
Blood Vessels
Triglycerides
Body Mass Index
Stroke
Transplants
Kidney

Keywords

  • Cardiovascular risk
  • Diabetes
  • Glucose
  • NODAT

ASJC Scopus subject areas

  • Transplantation

Cite this

Cardiovascular consequences of new-onset hyperglycemia after kidney transplantation. / Wauters, Rianne P.; Cosio, Fernando G; Suarez Fernandez, Maria L.; Kudva, Yogish C; Shah, Pankaj; Torres, Vicente.

In: Transplantation, Vol. 94, No. 4, 27.08.2012, p. 377-382.

Research output: Contribution to journalArticle

Wauters, Rianne P. ; Cosio, Fernando G ; Suarez Fernandez, Maria L. ; Kudva, Yogish C ; Shah, Pankaj ; Torres, Vicente. / Cardiovascular consequences of new-onset hyperglycemia after kidney transplantation. In: Transplantation. 2012 ; Vol. 94, No. 4. pp. 377-382.
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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.",
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AU - Shah, Pankaj

AU - Torres, Vicente

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N2 - 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.

AB - 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.

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