Prevalence and Risk Factors of Total Parenteral Nutrition Induced Hyperglycemia at a Single Institution: Retrospective Study.

Background: Total parenteral nutrition (TPN) provides full nutrition support to critically ill patients with an impaired digestive tract. Patients who receive TPN support are at higher risk for complications such as hyperglycemia. In our study, we aim to assess the prevalence of hyperglycemia induced by TPN and identify its risk factors in hospitalized adult patients. Methods: Patients who received TPN between January 2012 and December 2017 at University of Pittsburgh Medical Center-St. Margaret hospital were retrospectively screened. TPN-induced hyperglycemia was confirmed whether blood glucose was ≥180 mg/dL at any point, from the time of TPN initiation until 1-day post TPN termination. Characteristics of the hyperglycemia and the nonhyperglycemia groups were analyzed to predict potential risk factors. Results: A total of 197 patients were screened, 55 were excluded (1 died, 37 diabetic, and 17 had elevated blood glucose before TPN), and 142 patients were included, 42 of them (29.6%) developed hyperglycemia following TPN administration. Duration of TPN, surgical indications, and obesity were significantly higher in the hyperglycemia group. Additionally, age and steroids use were independent predictors of hyperglycemia in TPN patients after applying multivariable logistic regression model on our sample. Conclusions: Hyperglycemia is common after TPN. Risk factors assessment may help optimizing glycemic control in higher risk individuals to improve their outcomes. These include patients with obesity, surgical indication of TPN, and longer duration of TPN.

Metabolic disorders following kidney transplantation.

Kidney transplantation in patients suffering from end-stage renal disease, although beneficial, may result in potential complications increasing cardiovascular risk of mortality. Common metabolic problems after surgery are weight gain, hypertension, hyperlipidemia, and insulin resistance. Immunosuppressant therapy can enhance comorbidity progression. Early identification and treatment of these abnormalities can promote transplant function. Lifestyle modifications have shown to be promising in the reduction of the metabolic syndrome symptoms, but there remain limited trials focusing on this area. This article reflects a comprehensive review of the available research of each of the potential metabolic complications within the renal transplant population. Immunosuppressant medication effects, biochemical values, and medical nutrition therapy intervention are also included with regard to their influence with these metabolic disorders. Methods for review completion included a MEDLINE search for peer-reviewed research, using the following keywords: transplant, chronic kidney disease, nutrition, metabolic syndrome, and diet after transplantation.