Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss
© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA..
Background: Diabetes mellitus (DM) is associated with a greater risk of mortality in kidney transplant patients, primarily driven by a greater risk of cardiovascular disease (CVD)-related mortality. However, the associations between diabetes status at time of first allograft loss and mortality on dialysis remain unknown.
Methods: All patients with failed first kidney allografts transplanted in Australia and New Zealand between 2000 and 2020 were included. The associations between diabetes status at first allograft loss, all-cause and cause-specific mortality were examined using competing risk analyses, separating patients with diabetes into those with pre-transplant DM or post-transplant diabetes mellitus (PTDM).
Results: Of 3782 patients with a median (IQR) follow-up duration of 2.7 (1.1-5.4) years, 539 (14%) and 390 (10%) patients had pre-transplant DM or developed PTDM, respectively. In the follow-up period, 1336 (35%) patients died, with 424 (32%), 264 (20%) and 199 (15%) deaths attributed to CVD, dialysis withdrawal and infection, respectively. Compared to patients without DM, the adjusted subdistribution HRs (95% CI) for pre-transplant DM and PTDM for all-cause mortality on dialysis were 1.47 (1.17-1.84) and 1.47 (1.23-1.76), respectively; for CVD-related mortality were 0.81 (0.51-1.29) and 1.02 (0.70-1.47), respectively; for infection-related mortality were 1.84 (1.02-3.35) and 2.70 (1.73-4.20), respectively; and for dialysis withdrawal-related mortality were 1.71 (1.05-2.77) and 1.51 (1.02-2.22), respectively.
Conclusions: Patients with diabetes at the time of kidney allograft loss have a significant survival disadvantage, with the excess mortality risk attributed to infection and dialysis withdrawal.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:17 |
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| Enthalten in: |
Clinical kidney journal - 17(2024), 3 vom: 30. März, Seite sfad245 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Samarasinghe, Amali [VerfasserIn] |
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| Links: |
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| Themen: |
Allograft loss |
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| Anmerkungen: |
Date Revised 13.03.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1093/ckj/sfad245 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369584309 |
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| 245 | 1 | 0 | |a Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss |
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| 500 | |a published: Electronic-eCollection | ||
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| 520 | |a © The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. | ||
| 520 | |a Background: Diabetes mellitus (DM) is associated with a greater risk of mortality in kidney transplant patients, primarily driven by a greater risk of cardiovascular disease (CVD)-related mortality. However, the associations between diabetes status at time of first allograft loss and mortality on dialysis remain unknown | ||
| 520 | |a Methods: All patients with failed first kidney allografts transplanted in Australia and New Zealand between 2000 and 2020 were included. The associations between diabetes status at first allograft loss, all-cause and cause-specific mortality were examined using competing risk analyses, separating patients with diabetes into those with pre-transplant DM or post-transplant diabetes mellitus (PTDM) | ||
| 520 | |a Results: Of 3782 patients with a median (IQR) follow-up duration of 2.7 (1.1-5.4) years, 539 (14%) and 390 (10%) patients had pre-transplant DM or developed PTDM, respectively. In the follow-up period, 1336 (35%) patients died, with 424 (32%), 264 (20%) and 199 (15%) deaths attributed to CVD, dialysis withdrawal and infection, respectively. Compared to patients without DM, the adjusted subdistribution HRs (95% CI) for pre-transplant DM and PTDM for all-cause mortality on dialysis were 1.47 (1.17-1.84) and 1.47 (1.23-1.76), respectively; for CVD-related mortality were 0.81 (0.51-1.29) and 1.02 (0.70-1.47), respectively; for infection-related mortality were 1.84 (1.02-3.35) and 2.70 (1.73-4.20), respectively; and for dialysis withdrawal-related mortality were 1.71 (1.05-2.77) and 1.51 (1.02-2.22), respectively | ||
| 520 | |a Conclusions: Patients with diabetes at the time of kidney allograft loss have a significant survival disadvantage, with the excess mortality risk attributed to infection and dialysis withdrawal | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a allograft loss | |
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| 650 | 4 | |a kidney failure | |
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| 700 | 1 | |a Wong, Germaine |e verfasserin |4 aut | |
| 700 | 1 | |a Teixeira-Pinto, Armando |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, David W |e verfasserin |4 aut | |
| 700 | 1 | |a Hawley, Carmel |e verfasserin |4 aut | |
| 700 | 1 | |a Pilmore, Helen |e verfasserin |4 aut | |
| 700 | 1 | |a Mulley, William R |e verfasserin |4 aut | |
| 700 | 1 | |a Roberts, Matthew A |e verfasserin |4 aut | |
| 700 | 1 | |a Polkinghorne, Kevan R |e verfasserin |4 aut | |
| 700 | 1 | |a Boudville, Neil |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Christopher E |e verfasserin |4 aut | |
| 700 | 1 | |a Viecelli, Andrea K |e verfasserin |4 aut | |
| 700 | 1 | |a Ooi, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Larkins, Nicholas G |e verfasserin |4 aut | |
| 700 | 1 | |a Lok, Charmaine |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Wai H |e verfasserin |4 aut | |
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