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Nephrol Dial Transplant. 2017 Sep 1;32(9):1579-1586. doi: 10.1093/ndt/gfx205.

Incidence of hyperglycemia and diabetes and association with electrolyte abnormalities in pediatric solid organ transplant recipients.

Chanchlani R1,2,3,4, Joseph Kim S3,5, Kim ED2,6, Banh T2, Borges K2, Vasilevska-Ristovska J2, Li Y5, Ng V7,8,9, Dipchand AI8,9,10, Solomon M8,9,11, Hebert D1,8,9, Parekh RS1,2,3,5,6,8,9.

Author information

1
Department of Pediatrics, Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, ON, Canada.
2
Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
4
Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada.
5
Division of Nephrology, University Health Network and Department of Medicine, Toronto, ON, Canada.
6
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
7
Department of Pediatrics, Division of Pediatric Gastroenterology Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON, Canada.
8
Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
9
Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
10
Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada.
11
Department of Pediatrics, Division of Pediatric Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada.

Abstract

Background:

Posttransplant hyperglycemia is an important predictor of new-onset diabetes after transplantation, and both are associated with significant morbidity and mortality. Precise estimates of posttransplant hyperglycemia and diabetes in children are unknown. Low magnesium and potassium levels may also lead to diabetes after transplantation, with limited evidence in children.

Methods:

We conducted a cohort study of 451 pediatric solid organ transplant recipients to determine the incidence of hyperglycemia and diabetes, and the association of cations with both endpoints. Hyperglycemia was defined as random blood glucose levels ≥11.1 mmol/L on two occasions after 14 days of transplant not requiring further treatment. Diabetes was defined using the American Diabetes Association Criteria. For magnesium and potassium, time-fixed, time-varying and rolling average Cox proportional hazards models were fitted to evaluate the association with hyperglycemia and diabetes.

Results:

Among 451 children, 67 (14.8%) developed hyperglycemia and 27 (6%) progressed to diabetes at a median of 52 days (interquartile range 22-422) from transplant. Multi-organ recipients had a 9-fold [hazard ratio (HR) 8.9; 95% confidence interval (CI) 3.2-25.2] and lung recipients had a 4.5-fold (HR 4.5; 95% CI 1.8-11.1) higher risk for hyperglycemia and diabetes, respectively, compared with kidney transplant recipients. Both magnesium and potassium had modest or no association with the development of hyperglycemia and diabetes.

Conclusions:

Hyperglycemia and diabetes occur in 15 and 6% children, respectively, and develop early posttransplant with lung or multi-organ transplant recipients at the highest risk. Hypomagnesemia and hypokalemia do not confer significantly greater risk for hyperglycemia or diabetes in children.

KEYWORDS:

diabetes; hyperglycemia; hypokalemia; hypomagnesemia; solid organ transplant

PMID:
29059403
PMCID:
PMC5837606
DOI:
10.1093/ndt/gfx205
[Indexed for MEDLINE]
Free PMC Article

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