Impact of type 2 diabetes mellitus on kidney transplant rates and clinical outcomes among waitlisted candidates in a single center European experience

Caterina Dolla,Silvia Bruna Vanzino,Fabrizio Fop,Erika Naso,Luigi Biancone,Anna Allesina,Ester Gallo,Roberta Giraudi,Alberto Mella,Maria Cristina Torazza,Antonio Lavacca

doi:10.1038/s41598-020-78938-3

Abstract

Despite type 2 diabetes mellitus (T2D) is commonly considered a detrimental factor in dialysis, its clear effect on morbidity and mortality on waitlisted patients for kidney transplant (KT) has never been completely elucidated. We performed a retrospective analysis on 714 patients admitted to wait-list (WL) for their first kidney transplant from 2005 to 2010. Clinical characteristics at registration in WL (age, body mass index -BMI-, duration and modality of dialysis, underlying nephropathy, coronary artery -CAD- and/or peripheral vascular disease), mortality rates, and effective time on WL were investigated and compared according to T2D status (presence/absence). Data about therapy and management of T2D were also considered. At the time of WL registration T2D patients (n = 86) were older than non-T2D (n = 628) (58.7 ± 8.6 years vs 51.3 ± 12.9) with higher BMI (26.2 ± 3.8 kg/m2 vs 23.8 ± 3.6), more frequent history of CAD (33.3% vs 9.8%) and peripheral vascular disease (25.3% vs 5.8%) (p < 0.001 for all analyses). Considering overall population, T2D patients had reduced survival vs non-T2D (p < 0.001). Transplanted patients showed better survival in both T2D and non-T2D groups despite transplant rate are lower in T2D (75.6% vs 85.8%, p < 0.001). T2D was also associated to similar waiting time but longer periods between dialysis start and registration in WL (1.6 years vs 1.2, p = 0.008), comorbidity-related suspension from WL (571 days vs 257, p = 0.002), and increased mortality rate (33.7% vs 13.9% in the overall population, p < 0.001). In T2D patients admitted to WL, an history of vascular disease was significantly associated to low patient survival (p = 0.019). In conclusion, T2D significantly affects survival also on waitlisted patients. Allocation policies in T2D patients may be adjusted according to increased risk of mortality and WL suspension due to comorbidities.

Highlights

Despite type 2 diabetes mellitus (T2D) is commonly considered a detrimental factor in dialysis, its clear effect on morbidity and mortality on waitlisted patients for kidney transplant (KT) has never been completely elucidated
On the other hand few studies are focused on T2D patients who could be considered eligible for KT, and none of them at the best of our knowledge have evaluated if WL time—a variable directly correlated to negative outcome both for patient and KT7,8—could be influenced by the intrinsic T2D frailty for T2D-related comorbidities
In this study we investigate the effect of T2D on morbidity and mortality on waitlisted patients comparing the effective time on WL according to T2D status

Summary

Introduction

Despite type 2 diabetes mellitus (T2D) is commonly considered a detrimental factor in dialysis, its clear effect on morbidity and mortality on waitlisted patients for kidney transplant (KT) has never been completely elucidated. T2D was associated to similar waiting time but longer periods between dialysis start and registration in WL (1.6 years vs 1.2, p = 0.008), comorbidity-related suspension from WL (571 days vs 257, p = 0.002), and increased mortality rate (33.7% vs 13.9% in the overall population, p < 0.001). T2D long-term complications include disability, reduced quality of life, premature death, and end-stage kidney disease (ESKD)[2] with a consequent spreading percentage of dialytic patients affected by T2D3. In this population a multi-specialistic approach to prevent and manage T2D-related comorbidity is mandatory. In this study we investigate the effect of T2D on morbidity and mortality on waitlisted patients comparing the effective time on WL according to T2D status (presence/absence)

Methods

Results

Conclusion