Abstract
BackgroundThe incidence and risk factors for diabetic ketoacidosis (diabetic ketoacidosis) and hyperglycemic hyperosmolar syndrome (hyperglycemic hyperosmolar syndrome, previously called non-ketotic hyperosmolar coma) have not been reported in a national population of renal transplant (renal transplantation) recipients.MethodsWe performed a historical cohort study of 39,628 renal transplantation recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998, followed until 31 Dec 1999. Outcomes were hospitalizations for a primary diagnosis of diabetic ketoacidosis (ICD-9 code 250.1x) and hyperglycemic hyperosmolar syndrome (code 250.2x). Cox Regression analysis was used to calculate adjusted hazard ratios for time to hospitalization for diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.ResultsThe incidence of diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were 33.2/1000 person years (PY) and 2.7/1000 PY respectively for recipients with a prior diagnosis of diabetes mellitus (DM), and 2.0/1000 PY and 1.1/1000 PY in patients without DM. In Cox Regression analysis, African Americans (AHR, 2.71, 95 %CI, 1.96–3.75), females, recipients of cadaver kidneys, patients age 33–44 (vs. >55), more recent year of transplant, and patients with maintenance TAC (tacrolimus, vs. cyclosporine) had significantly higher risk of diabetic ketoacidosis. However, the rate of diabetic ketoacidosis decreased more over time in TAC users than overall. Risk factors for hyperglycemic hyperosmolar syndrome were similar except for the significance of positive recipient hepatitis C serology and non-significance of female gender. Both diabetic ketoacidosis (AHR, 2.44, 95% CI, 2.10–2.85, p < 0.0001) and hyperglycemic hyperosmolar syndrome (AHR 1.87, 95% CI, 1.22–2.88, p = 0.004) were independently associated with increased mortality.ConclusionsWe conclude that diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were associated with increased risk of mortality and were not uncommon after renal transplantation. High-risk groups were identified.
Highlights
The incidence and risk factors for diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome have not been reported in a national population of renal transplant recipients
We conclude that diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were associated with increased risk of mortality and were not uncommon after renal transplantation
Information on the incidence and risk factors for diabetic ketoacidosis after solid organ transplantation has been limited to single-center reports. [1,2,3,4] There are even fewer reports on hyperglycemic hyperosmolar syndrome after renal transplantation. [5,6] Recently, post-transplant diabetes mellitus has been associated with tacrolimus use in renal transplant recipients with hepatitis C antibody positivity, [7] this experience is not universal
Summary
The incidence and risk factors for diabetic ketoacidosis (diabetic ketoacidosis) and hyperglycemic hyperosmolar syndrome (hyperglycemic hyperosmolar syndrome, previously called non-ketotic hyperosmolar coma) have not been reported in a national population of renal transplant (renal transplantation) recipients. Renal transplant recipients are at high risk for post-transplant diabetes mellitus. [5,6] Recently, post-transplant diabetes mellitus has been associated with tacrolimus use in renal transplant recipients with hepatitis C antibody positivity, [7] this experience is not universal. Our objectives were to determine the incidence, risk factors, and mortality associated with hospitalizations for diabetic ketoacidosis (primary hospitalization discharge ICD9 code 250.1x) and hyperglycemic hyperosmolar syndrome (ICD9 code 250.2x) occurring after renal transplantation
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