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Access to renal transplantation in the diabetic population–effect of comorbidities and body mass index
Author(s) -
Patibandla Bhanu K.,
Narra Akshita,
DeSilva Ranil,
Chawla Varun,
GoldfarbRumyantzev Alexander S.
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2012.01661.x
Subject(s) - body mass index , medicine , transplantation , index (typography) , diabetes mellitus , population , endocrinology , computer science , environmental health , world wide web
Background In this study, we hypothesized that higher level of comorbidity and greater body mass index ( BMI ) may mediate the association between diabetes and access to transplantation. Methods We used data from the U nited S tates R enal D ata S ystem (01/01/2000–24/09/2007; n = 619 151). We analyzed two outcomes using C ox model: (i) time to being placed on the waiting list or transplantation without being listed and (ii) time to transplantation after being listed. Two primary C ox models were developed based on different levels of adjustment. Results In C ox models adjusted for a priori defined potential confounders, history of diabetes was associated with reduced transplant access (compared with non‐diabetic population) – both for wait‐listing/transplant without being listed (hazard ratio, HR = 0.80, p < 0.001) and for transplant after being listed ( HR = 0.72, p < 0.001). In C ox models adjusted for BMI and comorbidity index along with the potential confounders, history of diabetes was associated with shorter time to wait‐listing or transplantation without being listed ( HR = 1.07, p < 0.001), and there was no significant difference in time to transplantation after being listed ( HR = 1.01, p = 0.42). Conclusion We demonstrated that higher level of comorbidity and greater BMI mediate the association between diabetes and reduced access to transplantation.