Fernanda Ortiz1,2, Valma Harjutsalo3,2,4,5, Ilkka Helanterä6, Marko Lempinen6, Carol Forsblom3,2,4, Per-Henrik Groop3,2,4,7. 1. Nephrology, Abdominal Center, Helsinki University Hospital, Helsinki, Finland fernanda.ortiz@hus.fi. 2. Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. 3. Nephrology, Abdominal Center, Helsinki University Hospital, Helsinki, Finland. 4. Diabetes and Obesity, University of Helsinki Research Programs Unit, Helsinki, Finland. 5. Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland. 6. Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland. 7. Department of Diabetes, Monash University Central Clinical School, Melbourne, Victoria, Australia.
Abstract
OBJECTIVE: To examine time trends in mortality rates and causes of death in patients with type 1 diabetes and end-stage renal disease on dialysis and after kidney transplantation. RESEARCH DESIGN AND METHODS: In a nationwide retrospective cohort analysis, all patients with type 1 diabetes in Finland who received a kidney transplant alone were compared with patients who remained on dialysis. The main outcome was patient survival after starting dialysis. The cohort was divided into dialysis, functioning kidney transplant, and dialysis after transplant loss. Causes of death were retrieved and standardized mortality ratios calculated. RESULTS: We studied 2,383 patients. Patients survived a median of 15.9 years after a successful transplant, 11.2 years if transplant function was lost, and 2.9 years if they remained on chronic dialysis. Standardized mortality ratio decreased in all subgroups during the past four decades: from 2005 onwards, it was 3.9 in patients receiving a kidney transplant, 11.5 in patients with graft loss, and 32.5 in patients on dialysis. The most common cause of death in all patients was ischemic heart disease (45%) followed by infection (18%), which was more common in patients on dialysis. CONCLUSIONS: Kidney transplantation is the treatment of choice for patients with type 1 diabetes and end-stage renal disease because it substantially reduces the excess death risk when compared with dialysis. Even when kidney graft function is lost, the excess death risk is still considerably lower. Although overall mortality has decreased over the years, premature death due to ischemic heart disease remains high.
OBJECTIVE: To examine time trends in mortality rates and causes of death in patients with type 1 diabetes and end-stage renal disease on dialysis and after kidney transplantation. RESEARCH DESIGN AND METHODS: In a nationwide retrospective cohort analysis, all patients with type 1 diabetes in Finland who received a kidney transplant alone were compared with patients who remained on dialysis. The main outcome was patient survival after starting dialysis. The cohort was divided into dialysis, functioning kidney transplant, and dialysis after transplant loss. Causes of death were retrieved and standardized mortality ratios calculated. RESULTS: We studied 2,383 patients. Patients survived a median of 15.9 years after a successful transplant, 11.2 years if transplant function was lost, and 2.9 years if they remained on chronic dialysis. Standardized mortality ratio decreased in all subgroups during the past four decades: from 2005 onwards, it was 3.9 in patients receiving a kidney transplant, 11.5 in patients with graft loss, and 32.5 in patients on dialysis. The most common cause of death in all patients was ischemic heart disease (45%) followed by infection (18%), which was more common in patients on dialysis. CONCLUSIONS: Kidney transplantation is the treatment of choice for patients with type 1 diabetes and end-stage renal disease because it substantially reduces the excess death risk when compared with dialysis. Even when kidney graft function is lost, the excess death risk is still considerably lower. Although overall mortality has decreased over the years, premature death due to ischemic heart disease remains high.
Authors: Jessica L Harding; Meda Pavkov; Zhensheng Wang; Stephen Benoit; Nilka Ríos Burrows; Giuseppina Imperatore; Ann L Albright; Rachel Patzer Journal: BMJ Open Diabetes Res Care Date: 2021-05
Authors: U G Lange; S Rademacher; N Jahn; H-M Hau; B Zirnstein; R Sucher; K Semmling; P Bobbert; A A Lederer; D Buchloh; L Seidemann; D Seehofer Journal: BMC Nephrol Date: 2021-10-21 Impact factor: 2.388