Glycemic management and clinical outcomes in underserved minority kidney transplant recipients with type 2 and posttransplantation diabetes: A single-center retrospective study

Aleksić, Sandra; Eisenberg, Ruth; Tsomos, Effie; Anaraki, Sara Zahedpour; Japp, Emily; Upadhyay, Laxmi; Mowrey, Wenzhu; Akalin, Enver; Zonszein, Joel

doi:10.1016/j.diabres.2020.108221

Cited by 3 publications

(7 citation statements)

References 47 publications

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“…In our analysis, we noted a statistically significant 67% increased risk of all-cause mortality, ranging from 43 to 94%, in patients with PTDM as compared to non-diabetic controls. On close examination of the meta-analysis plot, it can be noted that seven of the 11 studies in the meta-analysis demonstrated a significant increase in mortality while no such difference was noted in four studies [ 27 , 28 , 31 , 32 ]. The contrasting results of three [ 27 , 28 , 31 ]of these four studies may be partly explained by their small sample size.…”

Section: Discussionmentioning

confidence: 99%

“…On close examination of the meta-analysis plot, it can be noted that seven of the 11 studies in the meta-analysis demonstrated a significant increase in mortality while no such difference was noted in four studies [ 27 , 28 , 31 , 32 ]. The contrasting results of three [ 27 , 28 , 31 ]of these four studies may be partly explained by their small sample size. On the other hand, the lack of significant results in the study of Kuo et al [ 32 ] may be somewhat explained by their non-standard criteria for diagnosing PTDM and shorter follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Impact of diabetes mellitus developing after kidney transplantation on patient mortality and graft survival: a meta-analysis of adjusted data

Lin

Yan

Yuan

et al. 2021

Diabetol Metab Syndr

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Background Post-transplant diabetes mellitus (PTDM) occurs in 10–30% of kidney transplant recipients. However, its impact on mortality and graft survival is still ambiguous. Therefore, the current study aimed to analyze if PTDM increases mortality and graft failure by pooling multivariable-adjusted data from individual studies. Methods PubMed, Embase, and CENTRAL, and Google Scholar were searched for studies comparing mortality and graft failure between PTDM and non-diabetic patients. Multivariable-adjusted hazard ratios (HR) were pooled in a random-effects model. Results Fourteen retrospective studies comparing 9872 PTDM patients with 65,327 non-diabetics were included. On pooled analysis, we noted a statistically significant increase in the risk of all-cause mortality in patients with PTDM as compared to non-diabetics (HR: 1.67 95% CI 1.43, 1.94 I2 = 57% p < 0.00001). The meta-analysis also indicated a statistically significant increase in the risk of graft failure in patients with PTDM as compared to non-diabetics (HR: 1.35 95% CI 1.15, 1.58 I2 = 78% p = 0.0002). Results were stable on sensitivity analysis. There was no evidence of publication bias on funnel plots. Conclusion Kidney transplant patients developing PTDM have a 67% increased risk of all-cause mortality and a 35% increased risk of graft failure. Further studies are needed to determine the exact cause of increased mortality and the mechanism involved in graft failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of diabetes mellitus developing after kidney transplantation on patient mortality and graft survival: a meta-analysis of adjusted data

Lin

Yan

Yuan

et al. 2021

Diabetol Metab Syndr

View full text Add to dashboard Cite

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“…For example, data from Aleksic and colleagues shows a reliance on older anti-glycaemic agents to manage diabetes after kidney transplantation in a real-world setting. 10 They also observed no mortality difference between PTDM and no diabetes, in contrast to pre-existing type 2 diabetes, 10 which differs from some of the existing literature.…”

Section: Introductionmentioning

confidence: 68%

“…From limited RWE data, clinical practice appears heterogenous and reported outcomes are conflicting. For example, data from Aleksic and colleagues shows a reliance on older anti‐glycaemic agents to manage diabetes after kidney transplantation in a real‐world setting 10 10 which differs from some of the existing literature.…”

Section: Introductionmentioning

confidence: 83%

“…For example, Aleksic and colleagues conducted a small retrospective analysis in 302 kidney transplant recipients and found minimal use of SGLT-2 inhibitors for managing diabetes. 10 However, encouraging class effects on cardio-renal outcomes have raised the SGLT-2 inhibitor profile dramatically, 24 and warrants targeted study in the setting of kidney transplantation. The second part of our study an important consideration for outcome research including PTDM.…”

Section: Discussionmentioning

confidence: 99%

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Comparing survival outcomes for kidney transplant recipients with pre‐existing diabetes versus those who develop post‐transplantation diabetes

et al. 2021

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Introduction:The aim of this study was to compare the management strategy and clinical outcomes for kidney transplant recipients with pre-transplant versus post-transplantation diabetes (PTDM) in a contemporary cohort.Methods: This is a single-centre, retrospective. observational study of kidney transplant recipients between 2007 and 2018 with follow-up to 31 December 2020. Data were extracted from hospital electronic patient records, with clinical outcomes linked to national data sets. PTDM was diagnosed by international consensus guidelines. Unadjusted and adjusted survival outcomes were assessed with Kaplan-Meier curves and Cox regression models, respectively, with PTDM handled as a time-varying covariate.Results: Data were analysed for 1,757 kidney transplant recipients, of whom 11.8% (n = 207) had pre-transplant diabetes, and 13.8% (n = 243) developed PTDM with median time to onset 108 days (IQR 46-549 days). Median followup was 1,839 days (IQR 928-2985 days). Disparate management strategies were observed, although insulin was the commonest glucose-lowering therapy for all patients with diabetes. In adjusted models, PTDM was associated with lower mortality (HR 0.663, 95% CI 0.543-0.810) and pre-diabetes with higher mortality (HR 1.675, 95% CI 1.396-2.011). However, if analyses are restricted to those with at least 5-year follow-up, then PTDM has no association with mortality (HR 0.771, 95% CI 0.419-1.096), but pre-transplant diabetes remains associated with higher mortality (HR 2.029, 95% CI 1.367-3.012).Conclusions: Pre-transplant diabetes remains associated with increased mortality risk after kidney transplantation, but PTDM effects are time dependent.Development of PTDM should be encouraged as a mandated registry return to study the long-term impact on survival outcomes.

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Kidney transplant outcomes in minority populations: can we close the gap?

Desai

Sodhi

Akkina

2021

Current Opinion in Organ Transplantation

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Purpose of review Health disparity in minority populations has been increasingly recognized over the last decade. The COVID-19 pandemic sheds a bright light on this very issue impressing upon the need for more research regarding healthcare in disparate populations. Although kidney transplantation remains the treatment of choice for end-stage renal disease management and longevity of life, access to transplantation remains a critical barrier in minority populations. The literature on disparity in access abounds but remains limited with regards to posttransplantation outcomes. The purpose of this review is to draw attention to existing research and literature in posttransplant outcomes and highlight the overall knowledge gap that persists in postkidney transplant care among disparate populations. Recent findings The current review focuses on important paradigm shifts in the determinants of outcomes in posttransplantation care in minority populations. It emphasizes a departure from immune mediated causes to more salient health inequities and socioeconomic factors contributing to patient and graft survival which require further investigation. Summary Despite increased awareness of health disparity in minority populations, outcomes data postkidney transplantation remains sparse. Critical to the future of kidney transplantation and improved healthcare coordination in minority populations will be a deeper understanding of contributing socio-economic variables in disparate outcomes.

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Glycemic management and clinical outcomes in underserved minority kidney transplant recipients with type 2 and posttransplantation diabetes: A single-center retrospective study

Cited by 3 publications

References 47 publications

Impact of diabetes mellitus developing after kidney transplantation on patient mortality and graft survival: a meta-analysis of adjusted data

Impact of diabetes mellitus developing after kidney transplantation on patient mortality and graft survival: a meta-analysis of adjusted data

Comparing survival outcomes for kidney transplant recipients with pre‐existing diabetes versus those who develop post‐transplantation diabetes

Kidney transplant outcomes in minority populations: can we close the gap?

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