학술논문
Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss.
Document Type
Academic Journal
Author
Samarasinghe A; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.; Wong G; School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, Australia.; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.; Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia.; Teixeira-Pinto A; School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, Australia.; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.; Johnson DW; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Queensland, Australia.; Australasian Kidney Trials Network, University of Queensland, Queensland, Australia.; Translational Research Institute, Queensland, Australia.; Hawley C; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Queensland, Australia.; Australasian Kidney Trials Network, University of Queensland, Queensland, Australia.; Translational Research Institute, Queensland, Australia.; Pilmore H; Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.; Department of Medicine, Auckland University, Auckland, New Zealand.; Mulley WR; Department of Nephrology, Monash Medical Centre, Melbourne, Australia.; Department of Medicine, Monash University, Melbourne, Australia.; Roberts MA; Eastern Health Clinical School, Monash University, Victoria, Australia.; Polkinghorne KR; Department of Nephrology and Medicine, Monash Medical Centre, Melbourne, Australia.; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Boudville N; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.; Internal Medicine, University of Western Australia Medical School, Perth, Australia.; Davies CE; Faculty of Health and Medical Science, Adelaide University Medical School, South Australia, Australia.; Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.; Viecelli AK; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Queensland, Australia.; Australasian Kidney Trials Network, University of Queensland, Queensland, Australia.; Ooi E; School of Biomedical Sciences, University of Western Australia, Western Australia, Australia.; Larkins NG; Department of Nephrology, Perth Children's Hospital, Perth, Western Australia, Australia.; School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.; Lok C; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Division of Nephrology, Department of Medicine, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.; Lim WH; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.; Internal Medicine, University of Western Australia Medical School, Perth, Australia.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 101579321 Publication Model: eCollection Cited Medium: Print ISSN: 2048-8505 (Print) Linking ISSN: 20488505 NLM ISO Abbreviation: Clin Kidney J Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2048-8505
Abstract
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.
Competing Interests: There are no conflicts of interest.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)
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.
Competing Interests: There are no conflicts of interest.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)