Brunkhorst Reinhard, Lufft Volkmar, Dannenberg Bettina, Kliem Volker, Tusch Günther, Pichlmayr Rudolf
Abt. Nephrologie, Zentrum Innere Medizin und Dermatologie, Medizinische Hochschule Hannover, Hannover, Germany.
Transplantation. 2003 Jul 15;76(1):115-9. doi: 10.1097/01.TP.0000070225.38757.81.
Diabetes mellitus is the leading cause of renal failure worldwide. The question of which treatment modality-hemodialysis versus renal transplantation-is associated with the lowest risk of cardiovascular morbidity and mortality in the diabetic end-stage renal disease (ESRD) population has not yet been investigated in a controlled trial.
We therefore conducted a case-control study of patients with ESRD caused by type 1 diabetes mellitus. The case patients were diabetics who received a renal graft between 1978 and 1997, whereas the controls were registered for renal transplantation but stayed on maintenance hemodialysis without ever undergoing transplantation. The groups were matched for age, sex, duration of diabetes, length of hemodialysis (up to the registration), and date of registration for renal transplantation.
Kaplan-Meier life table analysis, based on 46 case patients and 46 controls, demonstrated a highly significant (P=0.0001) poorer survival in the control group compared with the case group. Logistic regression showed that hemodialysis was a significant risk factor for death (P=0.0002) and cardiovascular morbidity (P=0.0023). Patients with cardiovascular complications such as coronary artery and peripheral vascular events were significantly more frequent in the control group. Additionally tested risk factors for cardiovascular complications (serum cholesterol, arterial blood pressure, number of antihypertensive drugs, serum calcium, serum phosphate, and glucose control [hemoglobin A(1c)]) showed no significant correlation to survival or morbidity in either group by logistic regression.
Renal transplantation is associated with a significantly improved survival compared with hemodialysis in patients with ESRD caused by type 1 diabetes mellitus. This seems to be a result of a reduced incidence of cardiovascular complications after renal transplantation.
糖尿病是全球肾衰竭的主要病因。在糖尿病终末期肾病（ESRD）患者群体中，哪种治疗方式——血液透析还是肾移植——与心血管疾病发病率和死亡率最低相关的问题，尚未在对照试验中进行研究。
因此，我们对1型糖尿病所致ESRD患者进行了一项病例对照研究。病例组患者为1978年至1997年间接受肾移植的糖尿病患者，而对照组为登记接受肾移植但一直维持血液透析且从未接受移植的患者。两组在年龄、性别、糖尿病病程、血液透析时长（至登记时）以及肾移植登记日期方面进行了匹配。
基于46例病例患者和46例对照的Kaplan-Meier生存表分析显示，与病例组相比，对照组的生存率显著更低（P = 0.0001）。逻辑回归分析表明，血液透析是死亡（P = 0.0002）和心血管疾病发病率（P = 0.0023）的显著危险因素。对照组中出现冠状动脉和外周血管事件等心血管并发症的患者明显更多。通过逻辑回归分析，另外检测的心血管并发症危险因素（血清胆固醇、动脉血压、抗高血压药物数量、血清钙、血清磷以及血糖控制[糖化血红蛋白A（1c）]）在两组中与生存率或发病率均无显著相关性。
对于1型糖尿病所致ESRD患者，肾移植与血液透析相比，生存率显著提高。这似乎是肾移植后心血管并发症发生率降低的结果。
