Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA
Introduction Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD).Research design and meth...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e001962.full |
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| author | Ann L Albright Jessica L Harding Giuseppina Imperatore Nilka Rios Burrows Meda Pavkov Zhensheng Wang Stephen Benoit Rachel Patzer |
| author_facet | Ann L Albright Jessica L Harding Giuseppina Imperatore Nilka Rios Burrows Meda Pavkov Zhensheng Wang Stephen Benoit Rachel Patzer |
| author_sort | Ann L Albright |
| collection | DOAJ |
| description | Introduction Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD).Research design and methods We included 254 188 first-time single kidney transplant recipients aged ≥18 years from the US Renal Data System (2000–2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000–2017), relative to the general US population, were assessed using Joinpoint regression.Results A total of 72 175 (28.4%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88%, 85% and 77% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively.Conclusions In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D. |
| format | Article |
| id | doaj-art-dd737e506afb4b15ab4cad7eba44ef69 |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-dd737e506afb4b15ab4cad7eba44ef692024-12-12T19:30:09ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2020-001962Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USAAnn L Albright0Jessica L Harding1Giuseppina Imperatore2Nilka Rios Burrows3Meda Pavkov4Zhensheng Wang5Stephen Benoit6Rachel Patzer7Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USADepartment of Surgery, Emory University School of Medicine, Atlanta, Georgia, USADivision of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USADivision of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USADivision of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USADepartment of Surgery, Emory University School of Medicine, Atlanta, Georgia, USADivision of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USADepartment of Medicine, Emory University School of Medicine, Atlanta, Georgia, USAIntroduction Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD).Research design and methods We included 254 188 first-time single kidney transplant recipients aged ≥18 years from the US Renal Data System (2000–2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000–2017), relative to the general US population, were assessed using Joinpoint regression.Results A total of 72 175 (28.4%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88%, 85% and 77% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively.Conclusions In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D.https://drc.bmj.com/content/9/1/e001962.full |
| spellingShingle | Ann L Albright Jessica L Harding Giuseppina Imperatore Nilka Rios Burrows Meda Pavkov Zhensheng Wang Stephen Benoit Rachel Patzer Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA BMJ Open Diabetes Research & Care |
| title | Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA |
| title_full | Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA |
| title_fullStr | Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA |
| title_full_unstemmed | Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA |
| title_short | Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA |
| title_sort | long term mortality among kidney transplant recipients with and without diabetes a nationwide cohort study in the usa |
| url | https://drc.bmj.com/content/9/1/e001962.full |
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