Disease progression and outcomes in type 1 diabetic kidney transplant recipients based on posttransplantation CKD staging.

BACKGROUND: Disease progression rates and outcomes per stage of kidney disease in kidney transplant recipients with type 1 diabetes mellitus are unknown.

STUDY DESIGN: Single-center retrospective cohort study.

SETTINGS & PARTICIPANTS: 276 kidney transplant recipients with type 1 diabetes mellitus and a functioning graft at 1 year posttransplantation.

PREDICTORS: Stage of chronic kidney disease at 1 year posttransplantation, donor source, and other clinical characteristics (covariates).

OUTCOMES & MEASUREMENTS: Slope of creatinine clearance, weighted average slopes of creatinine clearance in a subgroup of 60 patients, death-censored allograft and patient survival rates.

RESULTS: The median rate of creatinine clearance decrease after the first posttransplantation year was -1.6 mL/min/y (95% confidence interval [CI], -1.97 to -1.30) during a median follow-up of 8.4 years (95% CI, 8.13 to 8.84). The slope was significantly greater in stages 1 to 2 (-1.7 mL/min/y; 95% CI, -2.2 to -1.4) than stage 3 (-1.2 mL/min/y; 95% CI, -1.9 to -0.6; P = 0.0003). However, chronic kidney disease stage and donor source had no significant effect on death-censored allograft survival and patient survival rates. There were 23 deaths and 31 allograft losses in patients with stages 1 to 2 compared with 19 deaths and 18 allograft losses in those with stage 3. Univariate and multivariable Cox regression analyses showed that semiquantitative proteinuria of 1 or greater, mean arterial pressure, hematocrit of 33% or less, and calcineurin-inhibitor use were associated with decreased allograft survival, and age and hemoglobin A(1c) level of 7% or greater were significant risk factors for patient death regardless of donor type and stage of kidney function.

LIMITATIONS: Generalizability to other settings; study power.

CONCLUSION: All forms of kidney transplantation in patients with type 1 diabetes mellitus progressed at similar rates regardless of chronic kidney disease stage at 1 year posttransplantation. Age, anemia, hemoglobin A(1c) level, proteinuria, hypertension, and calcineurin-inhibitor use were associated with decreased allograft and patient outcomes.