Long-term cardio-kidney-metabolic (CKM) outcomes in living kidney donors with prediabetes
Poster #: 172
Session/Time: A
Author:
Imani Jami, BS
Mentor:
Mansai Shah, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Prediabetes and kidney donation are independent risk factors for chronic kidney disease (CKD). In the US, roughly one-third of adults have prediabetes, with 70% projected to develop diabetes. 40% of diabetics progress to CKD, and 7-8% develop end-stage renal disease (ESRD). Due to the kidney shortage, prediabetic individuals are increasingly accepted as donors, yet their long-term risks remain unclear. This study compared 10-year cardiometabolic outcomes among prediabetic donors (Cohort 1), donors without prediabetes (Cohort 2), and prediabetic non-donors (Cohort 3).
METHODS:
This retrospective cohort study utilized the TriNetX U.S. Collaborative Network to analyze outcomes from the time of index event (kidney donation for cohort 1 and 2, prediabetes for cohort 3) between June 2005 and June 2015. Prediabetes was defined as having impaired fasting glucose, impaired glucose tolerance, or elevated hemoglobin A1c (5.7-6.4%). Patients with diabetes at or before the index event were excluded. Each pair of cohorts underwent 1:1 propensity score matching (PSM) based on demographics, comorbidities, medications. Outcomes included diagnoses of diabetes, hypertension, CKD, proteinuria, hyperlipidemia, diabetic retinopathy, diabetic neuropathy, heart failure, acute myocardial infarction, stroke. Analyses were performed on TriNetX using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models on matched samples.
RESULTS:
TriNetX queries identified 989 patients in Cohort 1, 16,430 patients in Cohort 2, and 2,362,048 in Cohort 3 in the US. PSM resulted in 977 patients per cohort. Survival analyses indicated no significant differences in cardiometabolic outcomes between Cohort 1 and Cohort 2 over 10 years. Compared with Cohort 3, Cohort 1 demonstrated significantly lower risk of diabetes (HR, 0.28; 95% CI, 0.22-0.35), hypertension (HR, 0.61; 95% CI=0.53-0.71), hyperlipidemia (HR, 0.71; 95% CI, 0.61-0.83), but higher risk of CKD (HR, 3.02; 95% CI, 2.38-3.84) and proteinuria (HR, 1.92; 95% CI, 1.30-2.82). When compared to Cohort 3, Cohort 2 showed lower risk of diabetes (HR, 0.26; 95% CI, 0.24-0.27), hypertension (HR, 0.33; 95% CI, 0.32-0.35), hyperlipidemia (HR, 0.34; 95% CI, 0.33-0.36), diabetic retinopathy (HR, 0.72, 95% CI, 0.60-0.86), diabetic neuropathy (HR, 0.36; 95% CI, 0.29-0.41), heart failure (HR, 0.32; 95% CI, 0.29-0.35), acute myocardial infarction (HR, 0.32; 95% CI, 0.27-0.37), stroke (HR, 0.24, 95% CI, 0.20-0.28) but elevated risk of proteinuria (HR, 1.25; 95% CI=1.12-1.40) and CKD (HR, 1.44; 95% CI, 1.37-1.53).
CONCLUSION:
No significant differences were seen in cardiometabolic outcomes over a 10-year period among kidney donors with or without prediabetes, indicating that kidney donation does not inherently put pre-diabetic donors at a greater risk of developing diabetes. Surprisingly, prediabetic kidney donors had lower risk than prediabetic non-donors, suggesting lasting benefits of early diagnosis, lifestyle changes required for donor eligibility and follow-up care. However, increased risk of proteinuria and CKD in donors independent of diabetes implicate the role of single kidney. Limitations include retrospective study of 10-years, confined to US; prospective studies of longer duration are needed to confirm these findings.
Prediabetes and kidney donation are independent risk factors for chronic kidney disease (CKD). In the US, roughly one-third of adults have prediabetes, with 70% projected to develop diabetes. 40% of diabetics progress to CKD, and 7-8% develop end-stage renal disease (ESRD). Due to the kidney shortage, prediabetic individuals are increasingly accepted as donors, yet their long-term risks remain unclear. This study compared 10-year cardiometabolic outcomes among prediabetic donors (Cohort 1), donors without prediabetes (Cohort 2), and prediabetic non-donors (Cohort 3).
METHODS:
This retrospective cohort study utilized the TriNetX U.S. Collaborative Network to analyze outcomes from the time of index event (kidney donation for cohort 1 and 2, prediabetes for cohort 3) between June 2005 and June 2015. Prediabetes was defined as having impaired fasting glucose, impaired glucose tolerance, or elevated hemoglobin A1c (5.7-6.4%). Patients with diabetes at or before the index event were excluded. Each pair of cohorts underwent 1:1 propensity score matching (PSM) based on demographics, comorbidities, medications. Outcomes included diagnoses of diabetes, hypertension, CKD, proteinuria, hyperlipidemia, diabetic retinopathy, diabetic neuropathy, heart failure, acute myocardial infarction, stroke. Analyses were performed on TriNetX using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models on matched samples.
RESULTS:
TriNetX queries identified 989 patients in Cohort 1, 16,430 patients in Cohort 2, and 2,362,048 in Cohort 3 in the US. PSM resulted in 977 patients per cohort. Survival analyses indicated no significant differences in cardiometabolic outcomes between Cohort 1 and Cohort 2 over 10 years. Compared with Cohort 3, Cohort 1 demonstrated significantly lower risk of diabetes (HR, 0.28; 95% CI, 0.22-0.35), hypertension (HR, 0.61; 95% CI=0.53-0.71), hyperlipidemia (HR, 0.71; 95% CI, 0.61-0.83), but higher risk of CKD (HR, 3.02; 95% CI, 2.38-3.84) and proteinuria (HR, 1.92; 95% CI, 1.30-2.82). When compared to Cohort 3, Cohort 2 showed lower risk of diabetes (HR, 0.26; 95% CI, 0.24-0.27), hypertension (HR, 0.33; 95% CI, 0.32-0.35), hyperlipidemia (HR, 0.34; 95% CI, 0.33-0.36), diabetic retinopathy (HR, 0.72, 95% CI, 0.60-0.86), diabetic neuropathy (HR, 0.36; 95% CI, 0.29-0.41), heart failure (HR, 0.32; 95% CI, 0.29-0.35), acute myocardial infarction (HR, 0.32; 95% CI, 0.27-0.37), stroke (HR, 0.24, 95% CI, 0.20-0.28) but elevated risk of proteinuria (HR, 1.25; 95% CI=1.12-1.40) and CKD (HR, 1.44; 95% CI, 1.37-1.53).
CONCLUSION:
No significant differences were seen in cardiometabolic outcomes over a 10-year period among kidney donors with or without prediabetes, indicating that kidney donation does not inherently put pre-diabetic donors at a greater risk of developing diabetes. Surprisingly, prediabetic kidney donors had lower risk than prediabetic non-donors, suggesting lasting benefits of early diagnosis, lifestyle changes required for donor eligibility and follow-up care. However, increased risk of proteinuria and CKD in donors independent of diabetes implicate the role of single kidney. Limitations include retrospective study of 10-years, confined to US; prospective studies of longer duration are needed to confirm these findings.