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Risk factors for mortality in diabetic nephropathy patients accepted for transplantation
Bartlomiej J Witczak1, Trond Jenssen, Knut Endresen
1Department of Medicine, Section of Nephrology, Rikshospitalet, University of Oslo, Oslo, Norway. b.j.witczak@medisin.uio.no
Insights
Kidney or pancreas-kidney transplantation significantly reduces mortality risk in diabetic nephropathy patients. Medical treatment of coronary artery disease (CAD) prevents it from being a mortality risk factor post-transplant.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Diabetic nephropathy patients exhibit high rates of silent coronary artery disease (CAD).
- Investigating mortality risk factors, particularly CAD, is crucial for transplant candidates.
Purpose of the Study:
- To identify mortality risk factors in diabetic nephropathy patients awaiting kidney or pancreas-kidney transplantation.
- To assess the impact of coronary artery disease on mortality in this cohort.
Main Methods:
- 155 diabetic nephropathy patients underwent workup for kidney (KA) or simultaneous pancreas-kidney (SPK) transplantation between 1999-2004.
- Coronary angiography was performed on all patients; 136 were accepted for transplantation.
- Mean follow-up was 3.6 years, analyzing mortality in relation to transplant type, age, diabetes type, and duration.
Main Results:
- Simultaneous pancreas-kidney (SPK) transplantation showed higher survival rates (90% at 5 years) compared to kidney alone (KA) transplantation (76% at 5 years).
- Wait-listed patients had significantly lower survival (20% at 3 years).
- Multivariable analysis identified KA transplantation (HR=0.28), SPK transplantation (HR=0.09), age, type 2 diabetes, and diabetes duration as significant mortality factors.
Conclusions:
- Transplantation is the only modifiable risk factor, reducing mortality by up to 90%.
- Coronary artery disease (CAD) is not a mortality risk factor when medically treated and revascularized per guidelines.
Background:
There is a high incidence of silent coronary artery disease (CAD) in patients with diabetes. We wanted to investigate risk factors for mortality, and especially CAD, in a well-defined cohort of diabetic nephropathy transplant candidates accepted for transplantation.
Methods:
From 1999 through 2004, 155 patients underwent work up for living or deceased kidney (KA) or simultaneous pancreas-kidney (SPK) transplantation. The work up included coronary angiography for all patients and 136 were accepted. Mean (SD) age was 50 (12) years, 62% had type 1 diabetes, 73% were males, and 34% were on dialysis. Mean follow-up from time of acceptance for transplantation was 3.6 (1.9) years.
Results:
Survival of KA transplanted patients was 97% at 1 year, 89% at 3 years, and 76% at 5 years, whereas in SPK patients 100%, 94%, and 90%, respectively (P=0.065). One- and 3- year survival was only 57% and 20% in those remaining wait-listed (P<0.001). In univariate analysis mortality was associated with KA transplantation (hazard ratio [HR]=0.30, P=0.011) and SPK transplantation (HR=0.10, P=0.001), and age (HR=1.04, P=0.014). In multivariable analysis, KA transplantation (HR=0.28, P=0.006), SPK transplantation (HR=0.09, P=0.001), age (HR=1.06, P=0.002), type 2 diabetes (HR=0.14, P=0.003), and duration of diabetes (HR=0.94, P=0.019) were parameters associated with mortality.
Conclusions:
The only modifiable risk factor was transplantation with risk reduction up to 90%. CAD was not a risk factor for mortality when medically treated and revascularized according to standard guidelines.
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