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Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan

OBJECTIVES: Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular events (CVEs), and kidney transplantation (KT) has been reported to improve risk of CVEs and survival. As the association of KT timing on long-term survival and clinical outcomes remains unclear, we investi...

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Autores principales: Chen, Hsin-Hung, Chern, Yahn-Bor, Hsu, Chih-Yang, Tang, Pei-Ling, Lai, Chi-Cheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131177/
https://www.ncbi.nlm.nih.gov/pubmed/35613763
http://dx.doi.org/10.1136/bmjopen-2021-058033
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author Chen, Hsin-Hung
Chern, Yahn-Bor
Hsu, Chih-Yang
Tang, Pei-Ling
Lai, Chi-Cheng
author_facet Chen, Hsin-Hung
Chern, Yahn-Bor
Hsu, Chih-Yang
Tang, Pei-Ling
Lai, Chi-Cheng
author_sort Chen, Hsin-Hung
collection PubMed
description OBJECTIVES: Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular events (CVEs), and kidney transplantation (KT) has been reported to improve risk of CVEs and survival. As the association of KT timing on long-term survival and clinical outcomes remains unclear, we investigated the association of different KT waiting times with clinical outcomes. DESIGN: Retrospective observational cohort study. SETTING: We conducted an observational cohort study using data from the National Health Insurance Research Database in Taiwan. Adult patients who initiated KT therapy from 1997 to 2013 were included. PARTICIPANTS: A total of 3562 adult patients who initiated uncomplicated KT therapy were included and categorised into four groups according to KT waiting times after ESRD: group 1 (<1 year), group 2 (1–3 years), group 3 (3–6 years) and group 4 (>6 years). PRIMARY OUTCOME MEASURES: The main outcomes were composite of all-cause death, non-fatal myocardial infarction or non-fatal stroke, based on the primary diagnosis in medical records during hospitalisation. RESULTS: Compared with group 1, the adjusted risk of primary outcome events (all-cause death, non-fatal myocardial infarction or non-fatal stroke) increased by 1.67 times in group 2 (95% CI: 1.40 to 2.00; p<0.001), 2.17 times in group 3 (95% CI: 1.73 to 2.71; p<0.001) and 3.10 times in group 4 (95% CI: 2.21 to 4.35; p<0.001). The rates of primary outcome events were 6.7%, 13.4% and 14.0% within 5 years, increasing to 19.5%, 26.3% and 30.8% within 10 years in groups 1, 2 and 3, respectively. CONCLUSIONS: Our results demonstrate that early KT is associated with superior long-term cardiovascular outcomes compared with late KT in selected patients with ESRD receiving uncomplicated KT, suggesting that an early KT could be a better treatment option for patients with ESRD who are eligible for transplantation.
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spelling pubmed-91311772022-06-09 Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan Chen, Hsin-Hung Chern, Yahn-Bor Hsu, Chih-Yang Tang, Pei-Ling Lai, Chi-Cheng BMJ Open Epidemiology OBJECTIVES: Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular events (CVEs), and kidney transplantation (KT) has been reported to improve risk of CVEs and survival. As the association of KT timing on long-term survival and clinical outcomes remains unclear, we investigated the association of different KT waiting times with clinical outcomes. DESIGN: Retrospective observational cohort study. SETTING: We conducted an observational cohort study using data from the National Health Insurance Research Database in Taiwan. Adult patients who initiated KT therapy from 1997 to 2013 were included. PARTICIPANTS: A total of 3562 adult patients who initiated uncomplicated KT therapy were included and categorised into four groups according to KT waiting times after ESRD: group 1 (<1 year), group 2 (1–3 years), group 3 (3–6 years) and group 4 (>6 years). PRIMARY OUTCOME MEASURES: The main outcomes were composite of all-cause death, non-fatal myocardial infarction or non-fatal stroke, based on the primary diagnosis in medical records during hospitalisation. RESULTS: Compared with group 1, the adjusted risk of primary outcome events (all-cause death, non-fatal myocardial infarction or non-fatal stroke) increased by 1.67 times in group 2 (95% CI: 1.40 to 2.00; p<0.001), 2.17 times in group 3 (95% CI: 1.73 to 2.71; p<0.001) and 3.10 times in group 4 (95% CI: 2.21 to 4.35; p<0.001). The rates of primary outcome events were 6.7%, 13.4% and 14.0% within 5 years, increasing to 19.5%, 26.3% and 30.8% within 10 years in groups 1, 2 and 3, respectively. CONCLUSIONS: Our results demonstrate that early KT is associated with superior long-term cardiovascular outcomes compared with late KT in selected patients with ESRD receiving uncomplicated KT, suggesting that an early KT could be a better treatment option for patients with ESRD who are eligible for transplantation. BMJ Publishing Group 2022-05-23 /pmc/articles/PMC9131177/ /pubmed/35613763 http://dx.doi.org/10.1136/bmjopen-2021-058033 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Epidemiology
Chen, Hsin-Hung
Chern, Yahn-Bor
Hsu, Chih-Yang
Tang, Pei-Ling
Lai, Chi-Cheng
Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan
title Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan
title_full Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan
title_fullStr Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan
title_full_unstemmed Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan
title_short Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan
title_sort kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in taiwan
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131177/
https://www.ncbi.nlm.nih.gov/pubmed/35613763
http://dx.doi.org/10.1136/bmjopen-2021-058033
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