Abbott Kevin C, Bernet Victor J, Agodoa Lawrence Y, Yuan Christina M
Nephrology Service, Walter Reed Army Medical Center, Washington, D,C, and Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
BMC Endocr Disord. 2003 Mar 24;3(1):1. doi: 10.1186/1472-6823-3-1.
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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: We 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.
糖尿病酮症酸中毒（diabetic ketoacidosis）和高血糖高渗综合征（hyperglycemic hyperosmolar syndrome，以前称为非酮症高渗性昏迷）在全国肾移植（renal transplantation）受者人群中的发病率及危险因素尚未见报道。
我们对1994年7月1日至1998年6月30日期间美国肾脏数据系统中的39628例肾移植受者进行了一项历史性队列研究，随访至1999年12月31日。观察指标为以糖尿病酮症酸中毒（ICD - 9编码250.1x）和高血糖高渗综合征（编码250.2x）为主要诊断的住院情况。采用Cox回归分析计算糖尿病酮症酸中毒或高血糖高渗综合征住院时间的调整风险比。
既往诊断为糖尿病（DM）的受者中，糖尿病酮症酸中毒和高血糖高渗综合征的发病率分别为33.2/1000人年（person years，PY）和2.7/1000 PY，无DM的患者中分别为2.0/1000 PY和1.1/1000 PY。在Cox回归分析中，非裔美国人（调整后风险比[AHR]，2.71，95%可信区间[CI]，1.96 - 3.75）、女性、尸体肾受者、年龄33 - 44岁（对比>55岁）、移植年份较近以及使用他克莫司（TAC，对比环孢素）进行维持治疗的患者发生糖尿病酮症酸中毒的风险显著更高。然而，TAC使用者中糖尿病酮症酸中毒的发生率随时间下降幅度比总体更大。高血糖高渗综合征的危险因素与之相似，不同之处在于受者丙型肝炎血清学阳性具有显著性，而女性性别无显著性。糖尿病酮症酸中毒（AHR，2.44，95% CI，2.10 - 2.85，p < 0.0001）和高血糖高渗综合征（AHR 1.87，95% CI，1.22 - 2.88，p = 0.004）均与死亡率增加独立相关。
我们得出结论，糖尿病酮症酸中毒和高血糖高渗综合征与死亡率增加相关，且在肾移植后并不罕见。已确定高危人群。
