Risk factors for development of diabetic nephropathy and retinopathy in Jewish IDDM patients

Risk factors associated with diabetic microvascular complications, with special reference to ethnic origin, were looked for in 231 young Jewish insulin-dependent diabetes mellitus (IDDM) patients with duration of diabetes greater than or equal to 10 yr. Median age at diagnosis of diabetes was 9.2 yr (range 0.04-26.2 yr), and median duration of the disease was 15.3 yr (range 10.0-37.2 yr). Sixty-three percent of the patients were Ashkenazi Jews, and 37% were non-Ashkenazi Jews. HbA1 was evaluated every 3 mo in the last 10 yr of follow-up, and albumin excretion rate was tested in three 24-h urine collections. Direct and indirect ophthalmoscopy was performed every year since diagnosis of diabetes, and if retinal pathology was suspected, color photographs were taken. Microalbuminuria was detected in 31% and macroalbuminuria in 7% of the patients. Nonproliferative and proliferative retinopathy was found in 44 and 12% of the patients, respectively. On logistic regression analysis, two variables were significantly and independently associated with diabetic nephropathy--non-Ashkenazi origin and mean HbA1 values over the first 5 of 10 yr of follow-up. Variables significantly and independently related to diabetic retinopathy were non-Ashkenazi origin, mean HbA1 values over the last 10 yr of follow-up, and duration of diabetes. Because non-Ashkenazi Jews in Israel are of lower socioeconomic status than Ashkenazi Jews, we stratified our patients according to their socioeconomic parameters, median HbA1 values, and duration of diabetes. Non-Ashkenazi patients were at a higher risk to develop complications in all strata.(ABSTRACT TRUNCATED AT 250 WORDS)     

Kidney-pancreas transplantation for diabetic nephropathy

Pancreas transplantation is being performed with increasing frequency and increasing technical success. The availability of new immunosuppressant agents has been associated with a reduction in the previously high rates of allograft rejection in recipients of simultaneous pancreas-kidney transplants. These lower rejection rates have, in turn, led to changes in surgical techniques and a resurgence of interest in isolated pancreas transplantation--either in nonuremic patients or, more commonly, in patients who have already received a prior kidney transplant. Pancreas transplantation has emerged as an important option for the management of patients with type I diabetes mellitus and diabetic nephropathy.     

肾移植术后IgA肾病复发危险因素分析

目的 探讨肾移植术后IgA肾病复发的危险因素.方法 选取2008年1月—2019年12月在郑州人民医院器官移植中心接受肾移植的149例原发病为IgA肾病的肾衰竭患者为研究对象.根据程序性肾活检结果,将肾移植后是否有IgAN复发分为复发组(40例)和未复发组(109例).分别记录两组患者的性别、年龄、供体类型、透析时间、...     

Risk factors for contrast-induced nephropathy

An increasing number of diagnostic imaging and interventional procedures require the use of radiographic contrast agents which has led to a parallel increase in the incidence of contrast-induced nephropathy (CIN). CIN is a serious clinical problem associated with increased morbidity and mortality, particularly in patients with chronic renal failure (see the Case Report). A key step to minimize CIN is to identify patients at risk of CIN. The aim of the present review was to summarize the knowledge about the risk factors of CIN, including the review of ultimate clinical research and developments.     

Risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis and diabetic nephropathy: A 3-year follow-up study

This study aimed to explore the risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis (DFO) and diabetic nephropathy (DN). This is a prospective cohort study. Between May 2018 and May 2021, we selected 120 inpatients with comorbid severe diabetic foot infection (PEDIS Grade 3 or above) and DN for inclusion in our study. All cases were followed up for 36 months. The study outcomes were whether foot ulcer recurred and the time to recurrence. The risk factors of ulcer recurrence were analysed by comparing the data of the three groups. According to the recurrence of foot ulcer, the participants were divided into three groups: Group A (no foot ulcer recurrence, n = 89), Group B (foot ulcer recurrence within 12-36 months, n = 19) and Group C (foot ulcer recurrence within 6-12 months, n = 12). The multivariate Cox regression analysis showed that urine albumin-creatinine ratio (UACR) (HR: 1.008, 95% CI: 1.005-1.011, P < .001) and vibration perception threshold (VPT) (HR: 1.064, 95% CI: 1.032-1.096, P < .001) were identified as independent risk factors. Kaplan-Meier curves showed a significant positive association between UACR or VPT and the risk of foot ulcer recurrence (log rank, all P < .05). Areas under the ROC curves for UACR, VPT and the combination of UACR and VPT were 0.802, 0.799 and 0.842, respectively. The best cut-off values of UACR and VPT were 281.51 mg/g and 25.12 V, respectively. In summary, elevated UACR and VPT were independent risk factors. The best clinical cut-off values of UACR and VPT for prediction of foot ulcer recurrence were 281.51 mg/g and 25.12 V, respectively. Besides, our results suggested that microcirculation disorders rather than macrovascular complications play a major role in the recurrence of foot ulcer in patients with comorbid DFO and DN.     

Risk factors for mortality in children with diabetic keto acidosis from developing countries

Diabetic keto acidosis (DKA) is the major cause for mortality in children with Diabetes mellitus (DM). With increasing incidence of type 1 DM worldwide, there is an absolute increase of DM among children between 0-14 year age group and overall incidence among less than 30 years remain the same. This shift towards younger age group is more of concern especially in developing countries where mortality in DKA is alarmingly high. Prior to the era of insulin, DKA was associated with 100% mortality and subsequently mortality rates have come down and is now, 0.15%-0.31% in developed countries. However the scenario in developing countries like India, Pakistan, and Bangladesh are very different and mortality is still high in children with DKA. Prospective studies on DKA in children are lacking in developing countries. Literature on DKA related mortality are based on retrospective studies and are very recent from countries like India, Pakistan and Bangladesh. There exists an urgent need to understand the differences between developed and developing countries with respect to mortality rates and factors associated with increased mortality in children with DKA. Higher mortality rates, increased incidence of cerebral edema, sepsis, shock and renal failure have been identified among DKA in children from developing countries. Root cause for all these complications and increased mortality in DKA could be delayed diagnosis in children from developing countries. This necessitates creating awareness among parents, public and physicians by health education to identify symptoms of DM/DKA in children, in order to decrease mortality in DKA. Based on past experience in Parma, Italy it is possible to prevent occurrence of DKA both in new onset DM and in children with established DM, by simple interventions to increase awareness among public and physicians.     

Morbidity and mortality in diabetic patients following cardiac transplantation.

BACKGROUND: Diabetes remains a relative contraindication to cardiac transplantation. Previous reports have described small numbers of diabetic patients without end-organ damage who have undergone successful cardiac transplantation. METHODS: A retrospective analysis of diabetic patients transplanted and their outcome in a single large center from 1/1/95 to 12/31/99 was performed. Diabetes was defined as "medium risk" by the presence of any of the following parameters: duration of therapy >10 years; use of insulin; serum creatinine >2 mg/dl; urinary protein >300 mg per 24 hours; presence of peripheral vascular disease (ankle:brachial ratio <1.0); and documentation of other diabetic comorbidity (retinopathy, neuropathy, gastroparesis). RESULTS: During this time period, 374 adult cardiac transplants were performed. Seventy-six patients (20%) were diabetic with 33 patients (43%) requiring insulin. Forty-two of the patients had moderate disease. Survival of the diabetic and non-diabetic recipients was comparable (1- and 3-year survival of 86% and 85%. vs 87% and 84%, respectively, p = NS). No difference in survival between "medium-risk" and "low-risk" diabetics was observed. The incidence of acute rejection in the first year, graft vasculopathy and infection, was comparable between diabetic and non-diabetic patients. In both diabetic and non-diabetic patients, there was a similar and small insignificant increase in serum creatinine. CONCLUSIONS: More patients with advanced diabetes are undergoing cardiac transplantation and the early and mid-term survival remains comparable to non-diabetic recipients. Future liberalization of transplantation in diabetics appears likely.     

Risk factors for chronic allograft nephropathy after renal transplantation: a protocol biopsy study

BACKGROUND: Chronic allograft nephropathy (CAN) leads to chronic allograft dysfunction and loss. Regular renal transplant biopsies may be useful to find risk factors for CAN. METHODS: We carried out 688 protocol biopsies in 258 patients at 6, 12, and 26 weeks after renal transplantation. Patients with signs of CAN in the biopsy 3 (N= 70, CAN group), and those without (N= 120, non-CAN group), were compared. RESULTS: Chronic tubulointerstitial changes increased from biopsy 1 to 3 (5% vs. 37%, P < 0.0001). Fifty-six of 190 patients had acute rejection within 6 months (30%), 33 of which were found in protocol biopsies (17%). On univariate analysis, the CAN group had CAN more often at biopsy 2 than the non-CAN group (23% vs. 4%, P < 0.0001), had a lower calculated creatinine clearance at biopsy 1 and 2 (49.4 +/- 25.8 vs. 57 +/- 20.2 mL/min, P= 0.01; 47.3 +/- 21.2 vs. 57.9 +/- 19.5 mL/min, P= 0.001, respectively), had a living donor less often than a brain dead donor (7% vs. 18%, P= 0.045), had a longer cold ischemia time (17.4 +/- 7 vs. 14.9 +/- 8.1 hours, P= 0.04), and had arterionephrosclerosis more often (24% vs. 12%, P= 0.02). On multivariate analysis, the differences in CAN at biopsy 2 (P= 0.001) and lower GFR at biopsy 2 (P= 0.002) were confirmed; in addition, nephrocalcinosis (P= 0.006) and acute rejection (P= 0.046) were found to occur more often. CONCLUSION: Chronic tubulointerstitial changes develop early after renal transplantation and are associated with reduced kidney function. Risk factors for CAN are arterionephrosclerosis (donor-related), nephrocalcinosis (related to preexisting hyperparathyroidism), a long cold-ischemia time (ischemia-perfusion-related), and acute rejection. Renal functional decline precedes morphologic changes of CAN, expressed as tubular atrophy and interstitial fibrosis.     

成人良性终末期肝病肝移植术后中远期死亡的危险因素分析

目的 了解成人良性终末期肝病肝移植患者术后中远期的生存情况和导致中远期生存率下降的危险因素.方法 回顾性分析2003年10月至2007年6月行原位肝移植手术且术后存活时间超过1年的221例良性终末期肝病受者的资料,选取包括受者术前变量、供者变量、术中变量和受者术后变量共26个可能影响患者长期存活的危险因素,采用Cox回归分析筛选出影响肝移植受者术后长期存活的独立危险因素.结果 221例受者的随访率为97.3%(215/221),平均随访时间为(36.4±6.9)个月(12～56个月).其中28例在术后1年后死亡,主要死亡原因依次为感染(5.0%,11/221)、胆道并发症(3.6%,8/221)、乙型肝炎复发或再感染(1.4%,3/221).保留在Cox回归方程内的协变量为高龄(RR=2.325,P=0.009)、ABO血型(RR=2.206,P=0.015)、冷缺血时间(RR=3.001,P=0.000)、术后感染部位(RR=1.665,P=0.007)和胆道并发症(RR=2.655,P=0.004).结论 影响受者术后中远期存活的危险因素包括年龄≥60岁、ABO血型不符、冷缺血时间>12 h、术后肺部感染和移植肝胆管弥漫性狭窄.     

2型糖尿病合并骨质疏松相关因素的分析

目的探讨2型糖尿病合并骨质疏松的相关因素,并为进一步治疗提供相关依据。方法 2型糖尿病患者157例,男性79例,女性78例,其中分为合并骨质疏松组(OP)74例,未合并骨质疏松组(NOP)83例。分析比较这两组患者的性别、年龄、病程、体重指数(BMI)、血钙(Ca)、血磷(P)、碱性磷酸酶(ALP)、空腹血糖(FBG)、糖化血红蛋白(HBA1c)、尿微量白蛋白、血肌酐、甘油三酯(Tg)、总胆固醇(Tc)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、25羟基维生素D的差异。结果骨质疏松组与非骨质疏松组比较,性别、病程、BMI、HBA1c、血肌酐、尿微量白蛋白、25羟基维生素D有统计学差异性(P0.05),而Ca、P、ALP、FBG、Tg、Tc、HDL-C、LDL-C无统计学意义(P0.05);二元Logistic回归分析显示病程、BMI、HBA1c、25羟基维生素D与OP有关。结论病程、BMI、HBA1c、25羟基维生素D是影响2型糖尿病合并骨质疏松的相关因素。     

Combined pancreas and kidney transplantation improves survival in patients with end-stage diabetic nephropathy

The purpose of this study was to find out whether prolonged normoglycemia, as achieved by a successful pancreas transplantation, can improve survival in patients with insulin-dependent diabetes mellitus. A retrospective analysis of actual 10-yr patient survival rates was done for all renal graft recipients who were given transplants more than 10 yr ago but within the cyclosporin era (i.e. 1981-1988). The actual 10-yr patient survival rate in non-diabetic renal graft recipients was 72%, In recipients of pancreas and kidney grafts and with prolonged function of the pancreas graft, the survival rate was 60%, whereas in patients subjected to simultaneous pancreas and kidney transplantation, but where the pancreatic grafts failed within 2 yr, the survival rate was 33%. In diabetic recipients of kidney transplants alone, the survival rate was 37%. The patient survival rate was substantially higher in non-diabetic patients and patients with functioning pancreas grafts compared with diabetic patients with kidney transplants alone or with failed pancreas grafts. We speculate that the decrease in mortality was due to the beneficial effect of long-term normoglycemia on diabetic late complications.     

胰腺移植对大鼠糖尿病早期肾病的治疗

通过对大鼠肌注链脲霉素制成稳定的糖尿病模型后，尿中２４小时β２－微球蛋白、白蛋白排泄总量的检测，发现其均明显地高于正常水平，最高可达正常倍左右；并对胰腺移植后尿中增高的β２－微球蛋白、白蛋白，能重／１００克体重恢复情况进行观察，认为成功的胰腺移植可以使糖水病早期肾病的微量蛋白尿和增大的肾脏体积恢复正常。     

Risk factors for fractures in kidney transplantation

BACKGROUND: Risk factors for fracture after kidney transplantation need to be identified to target patients most likely to benefit from preventive measures. METHODS: Medical records were reviewed for 1572 kidney transplants done at a single center between February, l963 and May, 2000 with 6.5+/-5.4 years of follow-up. RESULTS: One or more fractures occurred in 300 (19.1%), with multiple fractures in 101 (6.4%). After excluding fractures of the foot or ankle (n=130 transplants, 8.3%), avascular necrosis (n=86, 5.5%), and vertebral fractures (n=28, 1.8%), there were one or more fractures in 196 (12.5%), with a cumulative incidence of 12.0%, 18.5%, and 23.0% at 5, 10, and 15 years, respectively. In multivariate Cox proportional hazards analysis, age had no effect on fractures in men. Compared with men and younger women, women 46-60 and >60 years old were, respectively, 2.11 (95% confidence interval 1.43-3.12, P=0.0002) and 3.47 (2.16-5.60, P<0.0001) times more likely to have fractures. Kidney failure from type 1 and 2 diabetes increased the risk by 2.08 (1.47-2.95, P<0.0001) and 1.92 (1.15-3.20, P=0.0131), respectively. A history of fracture pretransplant increased the risk by 2.15 (1.49-3.09, P<0.0001). Each year of pretransplant kidney failure increased the risk by 1.09 (1.05-1.14, P<0.0001). Obesity (body mass index >30 kg/m2) was associated with 55% (17-76%, P=0.0110) less risk. Different immunosuppressive medications, acute rejections, and multiple other factors were not independently associated with fractures. CONCLUSIONS: The population of transplant patients at high risk for fracture can be identified using age/gender, pretransplant fracture history, diabetes, obesity, and years of pretransplant kidney failure.     

Candidemia in Intensive Care patients. Risk factors and mortality

AIM: Aim of this study was to evaluate if the risk factors for candidemia could be used to identify patients who have a greater possibility of death after Candida spp blood infection. METHODS: A retrospective observational comparative study. SETTING: the Intensive Care Unit of an University Hospital. PATIENTS: 478 critical patients were included in this study. Neutropenic and immuno-suppressed patients were excluded. Interventions: routine care for acutely ill patients, with regard to their pathology. MEASUREMENTS: age, APACHE II at the admission, length of stay in the ICU before the diagnosis of candidemia and whole length of stay, outcome, risk factors for candidemia (Candida colonisation, previous antibiotic therapy, central vein, mechanical ventilation, abdominal surgery, hemodialysis, adult respiratory distress syndrome, chronic obstructive pulmonary disease, diabetes, malignancy, splenectomy, immunosuppression, total parenteral nutrition, malnutrition) and clinical signs of multiorgan failure, systemic inflammatory response syndrome, sepsis or shock, concomitant presence of other infections. RESULTS: Twelve Candida spp blood infections were diagnosed. All the risk factors were homogenously distributed between patients who survived and those who died with the exception of the malnutrition state, associated with a higher mortality rate. CONCLUSION: If the candidemia is present, none of the risk factors for the onset of fungemia considered in this study, but the malnutrition state, are mortality predictors.     

Risk factors for postoperative mortality in bariatric surgery

Introduction. Appropriate patient selection is crucial to the success of bariatric surgery (BaS). The objective of this study was to identify risk factors of increased postoperative mortality in patients undergoing BaS on a national level. Methods. BaS patients ≥18 years old in the United States were identified from the 2001 Nationwide Inpatient Sample (NIS). The effect of gender, age, insurance status, and need for reoperation on postoperative mortality was examined using multivariate logistic regression accounting for the NIS stratified sampling design and using comorbidity adjustments appropriate for index hospitalization data. Results. Analysis of 7,452,727 discharges identified 10,503 bariatric surgical patients meeting inclusion criteria. Estimates were generalizable to a national cohort of 52,098 patients with age 41 ± 10 years (mean ± SE), 84% women, length of stay (LOS) 3.9 ± 0.2 days, and overall mortality of 4 per 1000 BaS patients. Risk factors for postoperative in-hospital mortality are shown (Table). Mean LOS of those who died was 17.6 ± 3.7 days. Conclusion. Based on national data, risk factors for increased postoperative mortality in BaS patients include male gender, age > 39 years, Medicaid insured, and need for reoperation. These data can assist in optimizing BaS patient selection.

∗.

	% of BaS population	Odds ratio for death∗	95% Confidence interval∗	P value∗
Female	84	(ref)	(ref)
Male	16	2.1	1.1-4.3	0.04
Age 18-39	46	(ref)	(ref)
Age 40-49	32	2.6	1.1-6.5	0.04
Age 50-59	19	4.3	1.7-11	0.002
Private Insurance	83	(ref)	(ref)
Medicaid	4.7	3.9	1.2-13	0.03
No reoperation†	99	(ref)	(ref)
Reoperation	1	22	5.4-88	0.0001

∗

Adjusted for factors in table plus race, region and comorbidities;

†

Reoperation during original admission; ref = referent group

Full-size table