Author(s): Hjelmesaeth J, Hartmann A, Leivestad T, Holdaas H, Sagedal S,
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Abstract 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.
This article was published in Kidney Int
and referenced in Journal of Nephrology & Therapeutics