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Title: | Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss |
Authors: | Samarasinghe, A.;Wong, Germaine;Teixeira-Pinto, A.;Johnson, D. W.;Hawley, C.;Pilmore, H.;Mulley, W. R.;Roberts, M. A.;Polkinghorne, K. R.;Boudville, N.;Davies, C. E.;Viecelli, A. K.;Ooi, E.;Larkins, N. G.;Lok, C.;Lim, W. H. |
WSLHD Author: | Wong, Germaine |
Issue Date: | 2024 |
Citation: | Clinical Kidney Journal 17(3) (no pagination) 2024 |
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. |
URI: | https://wslhd.intersearch.com.au/wslhdjspui/handle/1/9735 |
DOI: | https://dx.doi.org/10.1093/ckj/sfad245 |
Journal: | Clinical Kidney Journal |
Type: | Journal Article |
Department: | Renal Medicine |
Facility: | Westmead |
Keywords: | diabetes dialysis kidney failure mortality Australia and New Zealand cerebrovascular disease cohort analysis diabetes mellitus graft failure hemodialysis incidence kidney allograft kidney transplantation peritoneal dialysis |
Appears in Collections: | Westmead Hospital 2019 - 2024 |
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