title: Disease progression and outcomes in type 1 diabetic kidney transplant recipients based on posttransplantation CKD staging.
abstract: BACKGROUND
  Disease progression rates and outcomes per stage of kidney disease in kidney transplant recipients with type 1 diabetes mellitus are unknown.
  
  
  METHODS
  Single-center retrospective cohort study.
  
  
  METHODS
  276 kidney transplant recipients with type 1 diabetes mellitus and a functioning graft at 1 year posttransplantation.
  
  
  METHODS
  Stage of chronic kidney disease at 1 year posttransplantation, donor source, and other clinical characteristics (covariates).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Generalizability to other settings; study power.
  
  
  CONCLUSIONS
  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.
authors: Department of Medicine, Nephrology Section, University of Wisconsin School of Medicine and Public Health, Madison, WI 53713, USA.
authors: Chanigan
authors: C
authors: Smavatkul
authors: Julio
authors: J
authors: Pascual
authors: Anand G
authors: AG
authors: Desai
authors: Millie
authors: M
authors: Samaniego
authors: Bryan N
authors: BN
authors: Becker
authors: Arjang
authors: A
authors: Djamali
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D016030:Kidney Transplantation / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome