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Glucose control is associated with patient survival in diabetic patients after renal transplantation

Franz Wiesbauer1, Georg Heinze, Heinz Regele

  • 1Department of Cardiology, Medical University of Vienna, Vienna, Austria.

Transplantation
|January 30, 2010
PubMed
Abstract

Insights

In diabetic kidney transplant patients, high maximal glucose levels and insulin treatment significantly increase mortality risk. However, these factors do not impact long-term graft survival in this population.

Area of Science:

  • Nephrology
  • Endocrinology
  • Transplantation

Background:

  • Tight glycemic control is proven effective for preventing death and renal failure in the general diabetic population.
  • The impact of diabetes treatment strategies on outcomes in diabetic renal-allograft recipients remains unclear.

Purpose of the Study:

  • To investigate the influence of glucose parameters and diabetes treatment on mortality and graft loss in diabetic renal-allograft recipients.
  • To identify specific glycemic control targets and treatment modalities that may affect patient and graft survival post-transplantation.

Main Methods:

  • A cohort study of 798 diabetic renal-allograft recipients transplanted between 1990 and 2004.
  • Utilized marginal-structural models and multivariable Cox regression analysis to control for confounding factors.
  • Analyzed the association between glucose parameters (maximal glucose, HbA1c) and diabetes treatment (diet, oral medication, insulin) with mortality and graft loss.

Main Results:

  • Maximal glucose levels, but not HbA1c, were independently associated with increased mortality.
  • Patients in the highest quartile of maximal glucose had a 2.2-fold increased risk of death.
  • Insulin treatment was associated with a 1.7-fold to 2.0-fold increased risk of death compared to diet or oral medication.
  • Neither glucose parameters nor diabetes treatment affected death-censored functional graft survival.

Conclusions:

  • Maximal glucose levels and insulin treatment are independent risk factors for mortality in diabetic renal-allograft recipients.
  • Current diabetes management strategies in this cohort did not influence graft survival.
  • Further research may be needed to optimize glycemic control and diabetes treatment to improve survival in this vulnerable patient group.

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