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Pretransplant HbA1c Is a Useful Predictor for the Development of New-Onset Diabetes in Renal Transplant Recipients Receiving No or Low-Dose Erythropoietin.

Tokodai K, Amada N, Haga I, Nakamura A, Kashiwadate T, Kawagishi N, Ohuchi N - Int J Endocrinol (2014)

Bottom Line: Seventeen patients (14.3%) developed NODAT within 1 year of transplantation.Receiver-operating characteristic analysis revealed a cut-off value of 5.2% with an optimal sensitivity of 64% and specificity of 78% for predicting NODAT.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Sendai Shakaihoken Hospital, Sendai 980-8574, Japan ; Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

ABSTRACT
Aims. To evaluate the predictive power of pretransplant HbA1c for new-onset diabetes after transplantation (NODAT) in kidney transplant candidates, who had several predispositions for fluctuated HbA1c levels. Methods. We performed a retrospective study of 119 patients without diabetes who received kidney transplantation between March 2000 and January 2012. Univariate and multivariate logistic regression analyses were used to investigate the association of several parameters with NODAT. Predictive discrimination of HbA1c was assessed using a receiver-operating characteristic curve. Results. Seventeen patients (14.3%) developed NODAT within 1 year of transplantation. Univariate logistic regression analysis revealed that recipient age, gender, and HbA1c were predictors of NODAT. In the multivariate analysis, the association between pretransplant HbA1c and NODAT development did not reach statistical significance (P = 0.07). To avoid the strong influence of high-dose erythropoietin on HbA1c levels, we performed subgroup analyses on 85 patients receiving no or low-dose (≤6000 IU/week) erythropoietin. HbA1c was again an independent predictor for NODAT. Receiver-operating characteristic analysis revealed a cut-off value of 5.2% with an optimal sensitivity of 64% and specificity of 78% for predicting NODAT. Conclusions. Our results reveal that the pretransplant HbA1c level is a useful predictor for NODAT in patients receiving no or low-dose erythropoietin.

No MeSH data available.


Related in: MedlinePlus

Flowchart of patient enrollment.
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fig1: Flowchart of patient enrollment.

Mentions: We retrospectively identified 193 consecutive patients who received living donor kidney transplants in our hospital between March 2000 and January 2012. Seventy-four patients were excluded from this study for the following reasons: pretransplant diabetes mellitus (n = 27), recipient age < 18 years (n = 8), insufficient data on HbA1c (n = 3), early graft or patient loss (n = 8), and cyclosporine-based immunosuppressive regimen (n = 28). Pretransplant diabetes was defined as the use of insulin or oral antihyperglycemic medications or fasting plasma glucose levels ≥ 126 mg/dL. Finally, a total of 119 patients were included in this study (Figure 1). For subgroup analysis, we identified 85 patients receiving no or low-dose (≤6,000 IU/week) EPO. To avoid detection bias, systematic, standardized, and periodic examinations of posttransplant glucose tolerance were performed on all patients regardless of pretransplant HbA1c levels. HbA1c was measured basically within 3 months prior to transplantation by high performance liquid chromatography (HPLC) method and estimated as a National Glycohemoglobin Standardization Program (NGSP) value. The HbA1c (Japan Diabetes Society (JDS)) was converted to HbA1c (NGSP) using the officially certified equation: NGSP (%) = 1.02 × JDS (%) + 0.25% [24]. The clinical data were collected retrospectively from the hospital data system and from clinical records in August 2013. The local institutional internal review board approved this study.


Pretransplant HbA1c Is a Useful Predictor for the Development of New-Onset Diabetes in Renal Transplant Recipients Receiving No or Low-Dose Erythropoietin.

Tokodai K, Amada N, Haga I, Nakamura A, Kashiwadate T, Kawagishi N, Ohuchi N - Int J Endocrinol (2014)

Flowchart of patient enrollment.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4216713&req=5

fig1: Flowchart of patient enrollment.
Mentions: We retrospectively identified 193 consecutive patients who received living donor kidney transplants in our hospital between March 2000 and January 2012. Seventy-four patients were excluded from this study for the following reasons: pretransplant diabetes mellitus (n = 27), recipient age < 18 years (n = 8), insufficient data on HbA1c (n = 3), early graft or patient loss (n = 8), and cyclosporine-based immunosuppressive regimen (n = 28). Pretransplant diabetes was defined as the use of insulin or oral antihyperglycemic medications or fasting plasma glucose levels ≥ 126 mg/dL. Finally, a total of 119 patients were included in this study (Figure 1). For subgroup analysis, we identified 85 patients receiving no or low-dose (≤6,000 IU/week) EPO. To avoid detection bias, systematic, standardized, and periodic examinations of posttransplant glucose tolerance were performed on all patients regardless of pretransplant HbA1c levels. HbA1c was measured basically within 3 months prior to transplantation by high performance liquid chromatography (HPLC) method and estimated as a National Glycohemoglobin Standardization Program (NGSP) value. The HbA1c (Japan Diabetes Society (JDS)) was converted to HbA1c (NGSP) using the officially certified equation: NGSP (%) = 1.02 × JDS (%) + 0.25% [24]. The clinical data were collected retrospectively from the hospital data system and from clinical records in August 2013. The local institutional internal review board approved this study.

Bottom Line: Seventeen patients (14.3%) developed NODAT within 1 year of transplantation.Receiver-operating characteristic analysis revealed a cut-off value of 5.2% with an optimal sensitivity of 64% and specificity of 78% for predicting NODAT.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Sendai Shakaihoken Hospital, Sendai 980-8574, Japan ; Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

ABSTRACT
Aims. To evaluate the predictive power of pretransplant HbA1c for new-onset diabetes after transplantation (NODAT) in kidney transplant candidates, who had several predispositions for fluctuated HbA1c levels. Methods. We performed a retrospective study of 119 patients without diabetes who received kidney transplantation between March 2000 and January 2012. Univariate and multivariate logistic regression analyses were used to investigate the association of several parameters with NODAT. Predictive discrimination of HbA1c was assessed using a receiver-operating characteristic curve. Results. Seventeen patients (14.3%) developed NODAT within 1 year of transplantation. Univariate logistic regression analysis revealed that recipient age, gender, and HbA1c were predictors of NODAT. In the multivariate analysis, the association between pretransplant HbA1c and NODAT development did not reach statistical significance (P = 0.07). To avoid the strong influence of high-dose erythropoietin on HbA1c levels, we performed subgroup analyses on 85 patients receiving no or low-dose (≤6000 IU/week) erythropoietin. HbA1c was again an independent predictor for NODAT. Receiver-operating characteristic analysis revealed a cut-off value of 5.2% with an optimal sensitivity of 64% and specificity of 78% for predicting NODAT. Conclusions. Our results reveal that the pretransplant HbA1c level is a useful predictor for NODAT in patients receiving no or low-dose erythropoietin.

No MeSH data available.


Related in: MedlinePlus