my personal edition > organ transplantation > news


  E-Mail this DGReview to a colleague

DGReview

Renal Transplantation Leads to Improved Survival Compared to Haemodialysis for Type 1 Diabetes Patients

Renal transplantation leads to a significantly improved survival rate compared with dialysis treatment for diabetic patients with end-stage renal disease, according to a German study.

Diabetic nephropathy is one of the most common causes of end-stage renal failure. However, diabetic patients are often excluded from dialysis and transplant programs, particularly because of the high prevalence of coronary artery disease in this population, and it remains unclear which treatment is associated with the lowest risk of cardiovascular complications.

To address this concern, Reinhard Brunkhorst, MD, from Hannover Medical School, Hannover, Germany, and colleagues performed a controlled retrospective analysis to compare the risk of cardiovascular morbidity and mortality in type 1 diabetes patients with end-stage renal disease (ESRD) on haemodialysis versus that in transplant recipients.

The case group for this study comprised 46 patients with type 1 diabetes and a diagnosis of diabetic nephropathy were selected from the Hannover Medical School transplant outpatient data bank as (mean age, 43 years; 31 males). One diabetic patient receiving dialysis treatment was selected from the transplantation waiting list as a control for each transplant patient, with matching for duration of dialysis and diabetes, age, sex, and year of treatment initiation.

Survival was significantly poorer in the control diabetic patients receiving dialysis compared with the transplant case patients (24 vs. 11 deaths, P=.0001), according to the researchers. Logistic regression analysis identified dialysis as the strongest risk factor for death (P=.0002), and as the only risk factor for cardiovascular events (coronary, peripheral, arterial, and cerebrovascular events; P<0.0023).

The researchers conclude that these findings "provide further evidence that diabetic patients with end-stage renal disease should undergo transplantation as early as possible or even pre-emptively."

They also note that, "the survival of patients with type 1 diabetes mellitus and end-stage renal failure is determined by their cardiovascular morbidity, irrespective of the mode of renal replacement therapy," and they stress the importance of minimising cardiovascular risk factors in these patients.
Transplantation, 2003 Jul 15;76:1:115-9. "Improved survival in patients with type 1 diabetes mellitus after renal transplantation compared with hemodialysis: a case-control study"

E-Mail this DGReview to a colleague

To print, use this version