Trends in mortality in adult first kidney transplant recipients with and without diabetes as cause of kidney failure: an ERA Registry study
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 StelAbstract
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.