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Observational Study
. 2022 Jul;5(4):e00281.
doi: 10.1002/edm2.281. Epub 2022 Apr 30.

Diabetic kidney disease versus non-diabetic kidney disease in type 2 diabetic patients on dialysis: An observational cohort

Arnaud Delautre  1   2 , Thierry Hannedouche  1   2 , Cécile Couchoud  3 , José Guiserix  4 , Damiano Cerasuolo  5 , François Chantrel  6 , Jonas Martzloff  1   2 , Nicolas Keller  1 , Thierry Krummel  1 ; REIN registry
Affiliations
Observational Study

Diabetic kidney disease versus non-diabetic kidney disease in type 2 diabetic patients on dialysis: An observational cohort

Arnaud Delautre et al. Endocrinol Diabetes Metab. 2022 Jul.

Abstract

Background: All chronic kidney diseases in diabetic patients are not diabetic kidney diseases. The objective was to compare the clinical characteristics, survival and access to transplantation in diabetic patients starting dialysis and classified either as diabetic kidney disease (DKD) or non-diabetic kidney disease in diabetic patients (NDKD).

Methods: We used the nationwide French REIN registry to analyse baseline clinical characteristics at dialysis inception and outcomes defined as kidney transplantation, deaths and their causes. The probability of death or transplantation was analysed using a multivariate Cox model and the Fine and Gray competing for risk model (sdHT).

Results: We included 65,136 patients from January 2009 to December 2015 with a median follow-up of 31 months. The cumulative incidence of kidney transplantation over eight years was 46.9% (44.8-48.9) in non-diabetic patients (ND), higher than the 19.3% (17.5-21.2) in the DKD group and 22.2% (18.4-26.7) in the NDKD group. The risk of death was significantly higher in the NDKD group than in the DKD group, even after accounting for the competing risk of transplantation (NDKD/sdHR 1.22; 95%CI 1.18-1.27; p < 0.005 vs. DKD/sdHR 1.12; 95%CI 1.08-1.16; p < 0.005 with adjustment for age, sex, major adverse cardiovascular events, cancer and chronic respiratory failure, compared to ND).

Conclusions: In diabetic patients starting dialysis, patients in the DKD group had reduced access to kidney transplantation. NDKD patients had a higher risk of mortality than DKD. The distinction between DKD and NDKD should be accounted for in the plan of care of diabetic patients starting dialysis.

Keywords: chronic kidney disease; diabetic kidney disease; mortality; transplantation; type 2 diabetes.

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Conflict of interest statement

The authors declared no conflict of interest in this work.

Figures

FIGURE 1
FIGURE 1
Survival analysis. Comparison of diabetic kidney disease (DKD), non‐diabetic kidney disease (NDKD) and non‐diabetic groups [Colour figure can be viewed at wileyonlinelibrary.com]]
FIGURE 2
FIGURE 2
Cumulative incidence of transplantation and death, over four years [Colour figure can be viewed at wileyonlinelibrary.com]]
See this image and copyright information in PMC

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