Ischemic heart disease biggest threat to type 1 diabetes patients after kidney transplant
medwireNews: Kidney transplantation greatly reduces mortality risk in people with type 1 diabetes and end-stage renal disease (ESRD), but premature death from ischemic heart disease remains common, report researchers.
Their study of all 1100 patients with type 1 diabetes to undergo kidney transplant in Finland since 1964 also shows improving survival over time, with the standard mortality ratio for those with kidney grafts, whether functioning or failed, decreasing by 58% between pre-1990 and after 2005.
Even the 1273 people who remained on dialysis had a 55% reduction in mortality risk over this period, although they remained more than 30 times more likely to die than the general population, compared with an excess risk increase of around five to 10-fold for people who underwent kidney transplantation.
The median survival time for patients who remained on dialysis was just 2.4 years, whereas this extended to 15.5 years in patients who received a transplant that remained functional. Even those whose graft failed, necessitating a return to dialysis, had a median survival time of 10.7 years.
However, Fernanda Ortiz (Helsinki University Hospital, Finland) and co-researchers observe that patients who remained on dialysis were older when they started renal replacement therapy than those in the transplant groups were, at 46 versus 36–41 years.
They suggest that “this group could have been more frail, with a longer duration of diabetes and its complications,” and so at a higher risk for death than the other patients. Frailty and multiple comorbidities may also explain why so many patients did not undergo kidney transplant, despite it being “the treatment of choice” in diabetes patients with ESRD.
There were no instances of patients dying while on the transplant waiting list, the team notes in Diabetes Care.
Among 1526 people with an established cause of death, the most common cause was ischemic heart disease, in 44.9%. This applied also to people who retained a functional graft, with 47.1% dying of this cause, followed by stroke (16.4%) and infections (13.7%). Infections, however, were more common in patients who remained on or returned to dialysis, at 18.2–25.1%.
The researchers stress that they were able to determine the cause of death for 92% of all patients who died and that their study therefore “provides a comprehensive and accurate picture of the comorbidities that affect patient survival.”
However, they also point out that patients in all groups died prematurely despite being screened for cardiovascular disease at the time of transplantation, in line with findings from general transplantation patients.
“This fact raises doubts about the efficacy of cardiovascular screening prior to transplantation,” they say.
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