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Renal transplant among type 1 and type 2 diabetes patients in Spain: A population-based study from 2002 to 2013

Published:August 09, 2016DOI:https://doi.org/10.1016/j.ejim.2016.07.031

      Highlights

      • Rates of renal transplant increased in type 2 diabetes patients over time.
      • Time trend analyses 2002–2013 showed increases in infections and rejection.
      • Infection rates were higher in people with T2DM/T1DM than in non-diabetic people.
      • We observed decreasing mortality rates during admission for renal transplant.
      • Diabetes was not associated with a higher in-hospital mortality.

      Abstract

      Background

      To describe trends in the rates and short-term outcomes of renal transplants (RTx) among patients with or without diabetes in Spain (2002–2013).

      Methods

      We used national hospital discharge data to select all hospital admissions for RTx. We divided the study period into four three-year periods. Rates were calculated stratified by diabetes status: type 1 diabetes (T1DM), type 2 diabetes (T2DM) and no-diabetes. We analyzed Charlson comorbidity index (CCI), post-transplant infections, in-hospital complications of RTx, rejection, in-hospital mortality and length of hospital stay.

      Findings

      We identified 25,542 RTx. Rates of RTx increased significantly in T2DM patients over time (from 9.3 cases/100,000 in 2002/2004 to 13.3 cases/100,000 in 2011/2013), with higher rates among people with T2DM for all time periods. T2DM patients were older and had higher CCI values than T1DM and non-diabetic patients (CCI ≥ 1, 31.4%, 20.4% and 21.5%, respectively; P < 0.05). Time trend analyses showed significant increases in infections, RTx-associated complications and rejection for all groups (all P values < 0.05). Infection rates were greater in people with T2DM (20.8%) and T1DM (23.5%) than in non-diabetic people (18.7%; P < 0.05). Time trend analyses (2002–2013) showed significant decreases in mortality during admission for RTx (OR 0.75, 95% CI 0.68–0.83). Diabetes was not associated with a higher in-hospital mortality (OR: 1.20, 95% CI 0.92–1.55).

      Interpretation

      RTx rates were higher and increased over time at a higher rate among T2DM patients. Mortality decreased over time in all groups. Diabetes does not predict mortality during admission for RTx.

      Funding

      Instituto Salud Carlos III and URJC-Banco Santander.

      Abbreviations:

      CCI (Charlson comorbidity index), CMBD (Conjunto Mínimo Básico de Datos, or Minimum Basic Data Set, the Spanish National Hospital Database), ESRD (End-stage renal disease), ICD-9-CM (International Classification of Diseases-Ninth Revision, Clinical Modification), IHM (In-hospital mortality), LOHS (Length of hospital stay), RTx (Renal transplantation), T1DM (Type 1 diabetes mellitus), T2DM (Type 2 diabetes mellitus)

      Keywords

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