Abstract：
OBJECTIVE:Observational studies have yielded inconsistent findings regarding the association of hemoglobin A(1c) (HbA(1c)) with survival in diabetic patients on dialysis. The association between pretransplant glycemic control and short- and long-term posttransplant outcomes in kidney transplant recipients is not clear. RESEARCH DESIGN AND METHODS:Linking the 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, we identified 2,872 diabetic dialysis patients who underwent first kidney transplantation. Mortality or graft failure and delayed graft function (DGF) risks were estimated by Cox regression (hazard ratio [HR]) and logistic regression (odds ratio), respectively. RESULTS:Patients were 53 ± 11 years old and included 36% women and 24% African Americans. In our fully adjusted model, allograft failure-censored, all-cause death HR and 95% CI for time-averaged pretransplant HbA(1c) categories of 7 to <8%, 8 to <9%, 9 to 10%, and ≥10%, compared with 6 to <7% (reference), were 0.89 (0.59-1.36), 2.06 (1.31-3.24), 1.41 (0.73-2.74), and 3.43 (1.56-7.56), respectively; and graft failure-censored cardiovascular death HR was 0.38 (0.13-1.05), 1.78 (0.69-4.55), 1.59 (0.44-5.76), and 4.28 (0.85-21.64), respectively. We did not find any difference in risk of death-censored graft failure or DGF with different pretransplant HbA(1c) levels. CONCLUSIONS:Poor pretransplant glycemic control appears associated with decreased posttransplant survival in kidney transplant recipients, whereas allograft outcomes may not be affected.
journal_name
Diabetes Carejournal_title
Diabetes careauthors
Molnar MZ,Huang E,Hoshino J,Krishnan M,Nissenson AR,Kovesdy CP,Kalantar-Zadeh Kdoi
10.2337/dc11-0906subject
Has Abstractpub_date
2011-12-01 00:00:00pages
2536-41issue
12eissn
0149-5992issn
1935-5548pii
dc11-0906journal_volume
34pub_type
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