Cardiovascular outcomes in kidney transplant patients with pre-existing peripheral arterial disease and diabetes mellitus.

IF 2.4 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Mohinder R Vindhyal, Sahith Mandala, Wan-Chi Chan, Rhythm Vasudeva, Suveenkrishna Pothuru, Harsh Mehta, Sania Jiwani, Kamal Gupta
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引用次数: 0

Abstract

Background: Kidney transplantation (KT) has been shown to enhance the quality of life, be more cost-effective, and reduce mortality in dialysis patients. We aimed to study the impact of pre-existing diabetes mellitus (DM) and peripheral arterial disease (PAD) on cardiovascular outcomes and mortality after kidney transplantation (KT). Materials and methods: A secondary USRDS (United States Renal Data System) analysis was performed from 2006 to 2017 in adult patients who underwent KT. The primary outcome was 3-year all-cause mortality, and secondary outcomes were myocardial infarction (MI), cerebrovascular accident, gangrene/limb ischemia, and graft failure. Adjusted hazard ratios were computed, and multivariate analysis was conducted. All p-values were 2-sided, and a value of <0.05 was deemed to be statistically significant. Statistical analyses were performed using the SAS 9.4 software. Results: A total of 51,009 patients with kidney transplants met the study inclusion/ exclusion criterion. Patients with both DM and PAD had the highest risk of mortality (15.3%, aHR 1.8, 1.6-2.0), followed by patients with PAD without DM (14.1%, aHR 1.6, 1.4-1.9), DM without PAD (9.9%, aHR 1.4, 1.3-2.6), and those without either DM or PAD (5.5%). MI was also higher in patients with DM and PAD (7.3%, aHR 1.8, 1.5-2.2), followed by DM alone (4.6%, aHR 1.58, 1.4-1.7), PAD alone (4.3%, aHR 1.14, 0.8-1.6), and no diabetes nor PAD (2.2%). Conclusions: In patients undergoing KT, those with pre-existing DM and/ or PAD have a significantly higher all-cause mortality and risk of MI.

伴有外周动脉疾病和糖尿病的肾移植患者的心血管预后
背景:肾移植(KT)已被证明可以提高透析患者的生活质量,更具成本效益,并降低死亡率。我们的目的是研究既往糖尿病(DM)和外周动脉疾病(PAD)对肾移植(KT)后心血管结局和死亡率的影响。材料和方法:从2006年到2017年,对接受KT的成年患者进行了二次USRDS(美国肾脏数据系统)分析。主要结局是3年全因死亡率,次要结局是心肌梗死(MI)、脑血管意外、坏疽/肢体缺血和移植物衰竭。计算调整后的风险比,并进行多变量分析。所有p值均为双侧,值为结果:共有51,009例肾移植患者符合研究纳入/排除标准。糖尿病和PAD合并的患者死亡风险最高(15.3%,aHR 1.8, 1.6-2.0),其次是PAD合并DM (14.1%, aHR 1.6, 1.4-1.9)、DM合并PAD (9.9%, aHR 1.4, 1.3-2.6)、DM合并PAD(5.5%)。糖尿病和PAD患者的心肌梗死发生率也较高(7.3%,aHR 1.8, 1.5-2.2),其次是单独糖尿病(4.6%,aHR 1.58, 1.4-1.7),单独PAD (4.3%, aHR 1.14, 0.8-1.6),无糖尿病和PAD(2.2%)。结论:在接受KT的患者中,那些先前存在DM和/或PAD的患者有更高的全因死亡率和心肌梗死的风险。
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来源期刊
CiteScore
3.90
自引率
11.10%
发文量
61
审稿时长
1 months
期刊介绍: Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology. The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation. Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.
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