Journal Article Ahead of print
PubMed: 42616007 DOI: 10.1093/ndt/gfag188
Trends in mortality in adult first kidney transplant recipients with and without diabetes as cause of kidney failure: an ERA Registry study.
Nephrol Dial Transplant
Authors: Laia Oliveras, Rianne Boenink, Anneke Kramer, Miha Arnol, Anders Åsberg, Sevcan A Bakkaloglu, Lukas Buchwinkler, Josep M Cruzado, Pietro Manuel Ferraro, Ilkka Helanterä, Viktorija Kuzema, Verónica López, Shona Methven, Nuria Montero, Marius A Øvrehus, Runolfur Palsson, Myriam Pastural, Olga L Rodríguez Arévalo, Mårten Segelmark, Søren S Sørensen, Aiko P J de Vries, Laurent Weekers, Kitty J Jager, Alberto Ortiz, Vianda S Stel
Affiliations
- Department of Nephrology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
- ERA Registry, Department of Medical Informatics, Amsterdam UMC - location University of Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands.
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet and Department of Pharmacy, University of Oslo, Oslo, Norway.
- Department of Pediatric Nephrology, Gazi University, Faculty of Medicine, Ankara, Turkiye.
- Austrian Dialysis and Transplantation Registry, Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
- Bellvitge Biomedical Research Institute (IDIBELL). University of Barcelona, Barcelona, Spain.
- Section of Nephrology, Department of Medicine, Università degli Studi di Verona; Nephrology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
- Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Department of Nephrology, Pauls Stradins Clinical University Hospital, Riga, Latvia.
- Department of Internal Diseases, Riga Stradins University, Riga, Latvia.
- Latvian Kidney Replacement Therapy Patients Registry, Riga, Latvia.
- Nephrology Department, Hospital Regional Universitario de Málaga; National Network for Kidney Research (RICORS2040, RD24/0004/0026), IBIMA, Universidad de Málaga, Málaga, Spain.
- Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
- Scottish Renal Registry, Public Health Scotland, UK.
- Department of Medicine, Div of Nephrology, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Section of Nephrology, Landspitali University Hospital, Reykjavik, Iceland.
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
- Agence de la biomedecine, Saint-Denis La Plaine, France.
- Registry of Kidney Patients of the Valencian Community, General Directorate of Public Health, Ministry of Health, Valencia, Spain.
- Health and Wellness Technologies, Polytechnic University of Valencia, Valencia, Spain.
- Department of Clinical Sciences, Lund University and Department of Endocrinology, Nephrology and Rheumatology, Skane University Hospital, Lund, Sweden.
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Leiden Transplant Center; and Dept of Medicine, Div of Nephrology, Leiden University Medical Center and Leiden University, Leiden, The Netherlands.
- Nephrology Department, CHU Liège, University of Liège, Liège, Belgium.
- Department of Nephrology and Hypertension, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), 28040 Madrid, Spain.
Abstract
BACKGROUND
Although all-cause and cause-specific mortality trends are well studied in the general population, these trends were less explored in kidney transplant recipients with and without diabetes. Our aim was to examine time trends in (cause-specific) mortality in adult first kidney transplant recipients with and without diabetes as the cause of kidney failure in European countries.
METHODS
We included adult patients who received a first kidney transplant between 2005 and 2022 from twelve European countries contributing data to the European Renal Association (ERA) Registry. We followed patients for a maximum of 5 years. We calculated age- and sex-standardised mortality rates, and the absolute and relative mortality differences between those with and without diabetes. Time trends were analyzed using Joinpoint regression.
RESULTS
In total, 134,231 adults received a kidney transplant between 2005 and 2022, and 20,753 (15.5%) of them had diabetes as the cause of kidney failure. Mortality rates for kidney transplant recipients with diabetes were almost twice as high as for recipients without diabetes (45.5 deaths per 1000 person-years (py) and 24.9 per 1000 py, respectively). The higher mortality of recipients with diabetes was mainly due to excess cardiovascular mortality and infection-related mortality. Trends in all-cause and cause-specific mortality remained stable over time up to the COVID-19 pandemic for recipients with and without diabetes. During the COVID-19 pandemic, both groups experienced an increase in mortality rates, mainly driven by an increase in infection-related mortality.
CONCLUSIONS
Contrary to trends observed in the general population, age- and sex-standardised all-cause and cardiovascular mortality rates among kidney transplant recipients, irrespective of diabetes status, did not improve over time. In addition, in contrast to the general population, the cardiovascular mortality gap in kidney transplant recipients with and without diabetes did not narrow over time.
MeSH
Diabetes Mellitus, Registries, Mortality, Kidney, Nephrology, Sex, Transplants, Pandemics, Renal Dialysis, Kidney Transplantation, Infections