Table 4.
Hazard ratio and 95% confidence interval of PTDM associated with 1% higher level of pretransplantation HbA1c, overall and stratified by erythropoietin use, anemia, induction agent, steroid maintenance, donor type, and components of metabolic syndrome
| Per 1% higher HbA1c | Range of pretransplantation HbA1c level |
P for change in slope | |
|---|---|---|---|
| 4 ≤ HbA1c < 5.4% | 5.4 ≤ HbA1c < 6.5% | ||
| Overall analyses (n = 1499) | |||
| Unadjusted HR (95% CI) | 1.02 (0.69, 1.50) | 2.29 (1.63, 3.22) | 0.01 |
| Adjusted HR (95% CI)a | 0.93 (0.65, 1.35) | 1.84 (1.31, 2.60) | 0.03 |
| Stratified analyses | Adjusted HRa (95% CI) | P-int | Adjusted HRa (95% CI) | P-int | |
|---|---|---|---|---|---|
| Erythropoietin use | |||||
| Yes (n = 532) | 1.29 (0.56, 3.00) | 0.33 | 1.81 (1.05, 3.11) | 0.94 | 0.60 |
| No (n = 967) | 0.80 (0.48, 1.23) | 1.86 (1.16, 2.97) | 0.03 | ||
| Anemiab | |||||
| Absent (n = 705) | 1.22 (0.67, 2.20) | 0.27 | 1.79 (1.00, 3.24) | 0.94 | 0.45 |
| Present (n = 794) | 0.80 (0.46, 1.27) | 1.86 (1.11, 3.10) | 0.05 | ||
| Induction agentc | |||||
| Steroid (n = 1087) | 1.02 (0.65, 1.62) | 0.31 | 1.87 (1.20, 2.93) | 0.34 | 0.12 |
| ATG (n = 699) | 1.34 (0.71, 2.53) | 1.82 (1.11, 2.99) | 0.53 | ||
| IL-2Ra (n = 510) | 1.14 (0.62, 2.08) | 1.70 (0.90, 3.08) | 0.48 | ||
| Steroid maintenance | |||||
| Yes (n = 904) | 1.01 (0.62, 1.64) | 0.43 | 1.79 (1.08, 2.95) | 0.52 | 0.21 |
| No (n = 595) | 0.83 (0.43, 1.60) | 2.18 (1.09, 4.36) | 0.11 | ||
| Donor type | |||||
| Living (n = 948) | 1.13 (0.61, 2.08) | 0.40 | 1.89 (1.16, 3.09) | 0.84 | 0.31 |
| Deceased (n = 551) | 0.75 (0.41, 1.35) | 1.75 (1.00, 3.05) | 0.08 | ||
| Metabolic syndrome | |||||
| Absent (n = 730) | 0.99 (0.55, 1.78) | 0.79 | 1.81 (0.90, 3.64) | 0.85 | 0.29 |
| Present (n = 769) | 0.87 (0.49, 1.55) | 1.95 (1.32, 2.88) | 0.04 | ||
| Body mass index | |||||
| < 30 kg/m2 (n = 1065) | 0.94 (0.55, 1.60) | 0.96 | 1.88 (1.23, 2.87) | 0.94 | 0.09 |
| ≥ 30 kg/m2 (n = 434) | 0.92 (0.48, 1.75) | 1.83 (1.04, 3.24) | 0.19 | ||
| Hypertension | |||||
| Absent (n = 254) | 1.20 (0.50, 2.90) | 0.55 | 1.68 (0.72, 3.91) | 0.75 | 0.66 |
| Present (n = 1245) | 0.88 (0.58, 1.35) | 1.95 (1.35, 2.82) | 0.02 | ||
| Low HDL-cholesterold | |||||
| Absent (n = 552) | 1.00 (0.48, 2.11) | 0.82 | 1.81 (0.89, 3.66) | 0.89 | 0.34 |
| Present (n = 947) | 0.90 (0.56, 1.43) | 1.92 (1.29, 2.86) | 0.03 | ||
| Serum triglyceride level | |||||
| < 150 mg/dl (n = 800) | 0.77 (0.46, 1.29) | 0.24 | 2.12 (1.30, 3.44) | 0.58 | 0.03 |
| ≥ 150 mg/dl (n = 699) | 1.31 (0.70, 2.46) | 1.72 (1.02, 2.90) | 0.58 | ||
Data are hazard ratios with confidence intervals in parentheses, unless otherwise specified.
ATG, antithymocyte globulin; CMV, cytomegalovirus; HCV, hepatitis C virus; HDL, high-density lipoprotein; HLA, human leukocyte antigen; HR, hazard ratio; IL-2Ra, interleukin-2 receptor antagonist; P-int, P-interaction; PTDM, posttransplantation diabetes mellitus; TG, triglyceride.
Adjusted for age, sex, race/ethnicity, history of cardiovascular disease, cause of end-stage renal disease, duration of pretransplantation dialysis, year of transplantation, number of prior transplantations, body mass index, history of hypertension, serum TG and HDL-cholesterol level, blood hemoglobin level, erythropoietin use, HLA mismatch, donor type and age, HCV and CMV serostatus, immunosuppressive agents, and time between date of HbA1c measured and date of transplantation.
Anemia was defined as blood hemoglobin < 11 g/dl.
Not exclusive categories.
Low HDL-cholesterol was defined as < 40 mg/dl in men and < 50 mg/dl in women.