Clinical
Pretransplant glycemic control affects kidney recipients’ survival
NEW YORK (Reuters Health) – Diabetics have better survival after kidney transplantation if their blood sugar levels were well controlled beforehand, a new study shows.
The finding suggests that glycemic control has an impact on diabetics’ outcomes even when the kidney transplant is successful, said senior investigator Dr. Kamyar Kalantar-Zadeh from the University of California, Los Angeles Medical Center in Torrance, in an email to Reuters Health.
Dr. Kalantar-Zadeh and colleagues analyzed data on 2872 diabetic dialysis patients who were followed for a median of 736 days after a first kidney transplantation.
Pretransplant hemoglobin (Hb)A1c levels were not associated with risk of graft failure or delayed graft function.
But compared to patients with a pretransplant HbA1c level between 6% and <7%, hazard ratios for all-cause mortality were 2.06 when pretransplant HbA1c was between 8% and <9%, and 3.43 with HbA1c levels of 10% or higher (kommentar Mono-S svenskt HbA1c 1% lägre, dvs 10% i artikeln blir 9% i Sverige – räkna gärna om till mmol/mol)
”Our study also showed that very low hemoglobin A1c (<5%) does not achieve better outcomes as opposed to <8%,” Dr. Kalantar-Zadeh wrote in his email.
”We suggest an A1c <8% for dialysis patients but also suggest to avoid very low A1c levels.”
Hazard ratios for cardiovascular death followed a similar pattern, the authors reported online October 12th in diabetes Care.
”Achieving good control of blood sugar in chronic dialysis patients is not only important for the greater survival during dialysis therapy, but also has important residual implications after dialysis therapy is replaced by a successful kidney transplant,” Dr. Kalantar-Zadeh said.
”We feel that in addition to hemoglobin A1c, other metrics of good vs. poor glycemic control should also be examined in dialysis patients, in whom A1c may not necessarily be the most reliable glycemic indicator.”
diabetes Care 2011 Dec
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