Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss
Date
2024
Authors
Samarasinghe, A.
Wong, G.
Teixeira-Pinto, A.
Johnson, D.W.
Hawley, C.
Pilmore, H.
Mulley, W.R.
Roberts, M.A.
Polkinghorne, K.R.
Boudville, N.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
CKJ: Clinical Kidney Journal, 2024; 17(3):sfad245-1-sfad245-12
Statement of Responsibility
Amali Samarasinghe, Germaine Wong, Armando Teixeira-Pinto, David W. Johnson, Carmel Hawley, Helen Pilmore, William R. Mulley, Matthew A. Roberts, Kevan R. Polkinghorne, Neil Boudville, Christopher E. Davies, Andrea K. Viecelli, Esther Ooi, Nicholas G. Larkins, Charmaine Lok, and Wai H. Lim
Conference Name
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.
School/Discipline
Dissertation Note
Provenance
Description
Access Status
Rights
© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/) , which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com