TY - JOUR
T1 - Enhanced posttransplant management of patients with diabetes improves patient outcomes
AU - Keddis, Mira T.
AU - El Ters, Mireille
AU - Rodrigo, Emilio
AU - Dean, Patrick
AU - Wohlfahrtova, Mariana
AU - Kudva, Yogish C.
AU - Lorenz, Elizabeth C.
AU - Cosio, Fernando G.
N1 - Funding Information:
We thank the Mayo Clinic transplant coordinators for their tireless efforts in patient follow-up and data collection. These studies were supported by grants from the Mayo Clinic Division of Nephrology and Hypertension.
PY - 2014/9
Y1 - 2014/9
N2 - The survival of patients with diabetes mellitus in the general population has improved in recent years. Here we assessed whether similar trends have occurred in 1688 kidney recipients, including 413 with diabetes prior to transplant between 1996 and 2007. Compared to patients without diabetes, the 5-year mortality was significantly increased (hazard ratio (HR) 2.68 (1.95-3.69)) due to higher cardiovascular-, infection-, and malignancy-related deaths in those with diabetes. However, 5-year mortality in patients with diabetes significantly declined over time (HR 0.883 (0.817-0.954)), narrowing the mortality difference between patients with and those without diabetes and in more recent years largely eliminating it. Post transplant, patients with diabetes experienced a significant decline in major fatal/nonfatal cardiac events (HR 0.853 (0.782-0.930)) and infectious deaths over time. In contrast, neither cardiac events nor overall mortality declined in recipients without diabetes. The decline in mortality due to diabetes did not relate to a reduced pretransplant risk profile and was independent of posttransplant variables. The use of cardioprotective medications and glycemic control improved over time post transplant. Furthermore, graft function and serum albumin significantly improved over time and these parameters related to better survival (albumin, HR 0.365 (0.223-0.599); eGFR, HR 0.803 (0.756-0.852)). Thus, survival of kidney recipients with diabetes mellitus has improved markedly since 1996 likely reflecting, at least in part, enhanced posttransplant management and outcomes.
AB - The survival of patients with diabetes mellitus in the general population has improved in recent years. Here we assessed whether similar trends have occurred in 1688 kidney recipients, including 413 with diabetes prior to transplant between 1996 and 2007. Compared to patients without diabetes, the 5-year mortality was significantly increased (hazard ratio (HR) 2.68 (1.95-3.69)) due to higher cardiovascular-, infection-, and malignancy-related deaths in those with diabetes. However, 5-year mortality in patients with diabetes significantly declined over time (HR 0.883 (0.817-0.954)), narrowing the mortality difference between patients with and those without diabetes and in more recent years largely eliminating it. Post transplant, patients with diabetes experienced a significant decline in major fatal/nonfatal cardiac events (HR 0.853 (0.782-0.930)) and infectious deaths over time. In contrast, neither cardiac events nor overall mortality declined in recipients without diabetes. The decline in mortality due to diabetes did not relate to a reduced pretransplant risk profile and was independent of posttransplant variables. The use of cardioprotective medications and glycemic control improved over time post transplant. Furthermore, graft function and serum albumin significantly improved over time and these parameters related to better survival (albumin, HR 0.365 (0.223-0.599); eGFR, HR 0.803 (0.756-0.852)). Thus, survival of kidney recipients with diabetes mellitus has improved markedly since 1996 likely reflecting, at least in part, enhanced posttransplant management and outcomes.
KW - cardiovascular morbidity
KW - cardiovascular mortality
KW - diabetes mellitus
KW - patient survival
UR - http://www.scopus.com/inward/record.url?scp=84907597998&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84907597998&partnerID=8YFLogxK
U2 - 10.1038/ki.2014.70
DO - 10.1038/ki.2014.70
M3 - Article
C2 - 24694990
AN - SCOPUS:84907597998
SN - 0085-2538
VL - 86
SP - 610
EP - 618
JO - Kidney international
JF - Kidney international
IS - 3
ER -