Mortality risk for kidney transplant candidates with diabetes: a population cohort study.

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetologia Pub Date : 2024-11-01 Epub Date: 2024-08-06 DOI:10.1007/s00125-024-06245-x
Raja Rashid, Daoud Chaudhry, Felicity Evison, Adnan Sharif
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Abstract

Aims/hypothesis: It is unclear whether kidney transplant candidates with diabetes have equitable transplantation opportunities or have divergent survival probabilities stratified by kidney replacement therapy. The aim of this study was to investigate these two issues using national transplant registry data in the UK.

Methods: A cohort study was undertaken of prospectively collected registry data of all wait-listed people with kidney failure receiving dialysis in the UK. All people listed for their first kidney-alone transplant between 2000 and 2019 were included. Stratification was done for cause of kidney failure. Primary outcome was all-cause mortality. Time-to-death from listing was analysed using adjusted non-proportional hazard Cox regression models, with transplantation handled as a time-dependent covariate.

Results: A total of 47,917 wait-listed people with kidney failure formed the total study cohort, of whom 6594 (13.8%) had diabetes classified as cause of kidney failure. People with kidney failure with diabetes comprised 27.6% of the cohort (n=3681/13,359) that did not proceed to transplantation vs only 8.4% (n=2913/34,558) of the cohort that received a transplant (p<0.001). Kidney transplant candidates with diabetes were more likely to be older, of male sex and of ethnic minority background compared with those without diabetes. In an adjusted analysis, compared with remaining on dialysis, any kidney transplant provided survival benefit for wait-listed kidney transplant candidates regardless of diabetes as cause of kidney failure (RR 0.26 [95% CI 0.25, 0.27], p<0.001).

Conclusions/interpretation: Kidney transplant candidates with diabetes have a lower chance of transplantation despite better survival after kidney transplantation vs remaining on dialysis. The reasons for this require further investigation to ensure equal transplantation opportunities.

Abstract Image

糖尿病肾移植候选者的死亡风险:一项人群队列研究。
目的/假设:目前尚不清楚糖尿病肾移植候选者是否拥有公平的移植机会,或者根据肾脏替代疗法的不同,其存活概率也不同。本研究旨在利用英国全国移植登记数据调查这两个问题:对英国所有等待移植的肾衰竭透析患者的登记数据进行了一项前瞻性收集的队列研究。研究纳入了 2000 年至 2019 年期间首次接受肾脏移植的所有患者。根据肾衰竭的原因进行了分层。主要结果为全因死亡率。使用调整后的非比例危险 Cox 回归模型分析了从列名到死亡的时间,并将移植作为随时间变化的协变量处理:共有 47917 名肾衰竭候补患者组成了研究队列,其中 6594 人(13.8%)的肾衰竭原因归类为糖尿病。患有糖尿病的肾衰竭患者在未进行移植的队列中占27.6%(n=3681/13359),而在接受移植的队列中仅占8.4%(n=2913/34558)(p结论/解释:尽管肾移植后的存活率高于继续透析,但患有糖尿病的肾移植候选者接受移植的几率较低。其原因需要进一步调查,以确保平等的移植机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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