Abstract
Both type 1 diabetes mellitus and end-stage renal disease are associated with increased fracture risk, likely because of metabolic abnormalities that reduce bone strength. Simultaneous pancreas-kidney transplantation is a treatment of choice for patients with both disorders, yet the effects of simultaneous pancreas-kidney and kidney transplantation alone on post-transplantation fracture risk are unknown. From the United States Renal Data System, we identified 11,145 adults with type 1 diabetes undergoing transplantation, of whom 4933 had a simultaneous pancreas-kidney transplant and 6212 had a kidney-alone transplant between 2000 and 2006. Post-transplantation fractures resulting in hospitalization were identified from discharge codes. Time to first fracture was modeled and propensity score adjustment was used to balance covariates between groups. Fractures occurred in significantly fewer (4.7%) of pancreas-kidney compared with kidney-alone transplant (5.9%) cohorts. After gender stratification and adjustment for fracture covariates, pancreas-kidney transplantation was associated with a significant 31% reduction in fracture risk in men (hazard risk 0.69). Older age, white race, prior dialysis, and pre-transplantation fracture were also associated with increased fracture risk. Prospective studies are needed to determine the gender-specific mechanisms by which pancreas-kidney transplantation reduces fracture risk in men.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 471-478 |
| Number of pages | 8 |
| Journal | Kidney International |
| Volume | 83 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2013 |
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Keywords
- diabetes
- fracture
- renal
- transplantation
- USRDS
ASJC Scopus subject areas
- Nephrology
Cite this
Pancreas-kidney transplantation is associated with reduced fracture risk compared with kidney-alone transplantation in men with type 1 diabetes. / Nikkel, Lucas E.; Iyer, Sapna P.; Mohan, Sumit; Zhang, Amy; Mcmahon, Donald J.; Tanriover, Bekir; Cohen, David J.; Ratner, Lloyd; Hollenbeak, Christopher S.; Rubin, Mishaela R.; Shane, Elizabeth; Nickolas, Thomas L.
In: Kidney International, Vol. 83, No. 3, 03.2013, p. 471-478.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Pancreas-kidney transplantation is associated with reduced fracture risk compared with kidney-alone transplantation in men with type 1 diabetes
AU - Nikkel, Lucas E.
AU - Iyer, Sapna P.
AU - Mohan, Sumit
AU - Zhang, Amy
AU - Mcmahon, Donald J.
AU - Tanriover, Bekir
AU - Cohen, David J.
AU - Ratner, Lloyd
AU - Hollenbeak, Christopher S.
AU - Rubin, Mishaela R.
AU - Shane, Elizabeth
AU - Nickolas, Thomas L.
PY - 2013/3
Y1 - 2013/3
N2 - Both type 1 diabetes mellitus and end-stage renal disease are associated with increased fracture risk, likely because of metabolic abnormalities that reduce bone strength. Simultaneous pancreas-kidney transplantation is a treatment of choice for patients with both disorders, yet the effects of simultaneous pancreas-kidney and kidney transplantation alone on post-transplantation fracture risk are unknown. From the United States Renal Data System, we identified 11,145 adults with type 1 diabetes undergoing transplantation, of whom 4933 had a simultaneous pancreas-kidney transplant and 6212 had a kidney-alone transplant between 2000 and 2006. Post-transplantation fractures resulting in hospitalization were identified from discharge codes. Time to first fracture was modeled and propensity score adjustment was used to balance covariates between groups. Fractures occurred in significantly fewer (4.7%) of pancreas-kidney compared with kidney-alone transplant (5.9%) cohorts. After gender stratification and adjustment for fracture covariates, pancreas-kidney transplantation was associated with a significant 31% reduction in fracture risk in men (hazard risk 0.69). Older age, white race, prior dialysis, and pre-transplantation fracture were also associated with increased fracture risk. Prospective studies are needed to determine the gender-specific mechanisms by which pancreas-kidney transplantation reduces fracture risk in men.
AB - Both type 1 diabetes mellitus and end-stage renal disease are associated with increased fracture risk, likely because of metabolic abnormalities that reduce bone strength. Simultaneous pancreas-kidney transplantation is a treatment of choice for patients with both disorders, yet the effects of simultaneous pancreas-kidney and kidney transplantation alone on post-transplantation fracture risk are unknown. From the United States Renal Data System, we identified 11,145 adults with type 1 diabetes undergoing transplantation, of whom 4933 had a simultaneous pancreas-kidney transplant and 6212 had a kidney-alone transplant between 2000 and 2006. Post-transplantation fractures resulting in hospitalization were identified from discharge codes. Time to first fracture was modeled and propensity score adjustment was used to balance covariates between groups. Fractures occurred in significantly fewer (4.7%) of pancreas-kidney compared with kidney-alone transplant (5.9%) cohorts. After gender stratification and adjustment for fracture covariates, pancreas-kidney transplantation was associated with a significant 31% reduction in fracture risk in men (hazard risk 0.69). Older age, white race, prior dialysis, and pre-transplantation fracture were also associated with increased fracture risk. Prospective studies are needed to determine the gender-specific mechanisms by which pancreas-kidney transplantation reduces fracture risk in men.
KW - diabetes
KW - fracture
KW - renal
KW - transplantation
KW - USRDS
UR - http://www.scopus.com/inward/record.url?scp=84874661689&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874661689&partnerID=8YFLogxK
U2 - 10.1038/ki.2012.430
DO - 10.1038/ki.2012.430
M3 - Article
C2 - 23283136
AN - SCOPUS:84874661689
VL - 83
SP - 471
EP - 478
JO - Kidney International
JF - Kidney International
SN - 0085-2538
IS - 3
ER -