Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Clin Transplant. 2012 May-Jun;26(3):E307-15. doi: 10.1111/j.1399-0012.2012.01661.x.
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.
We used data from the United States Renal Data System (01/01/2000-24/09/2007; n = 619,151). We analyzed two outcomes using Cox 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 Cox models were developed based on different levels of adjustment.
In Cox 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 Cox 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).
We demonstrated that higher level of comorbidity and greater BMI mediate the association between diabetes and reduced access to transplantation.
在这项研究中，我们假设更高的合并症水平和更大的体重指数（BMI）可能会调节糖尿病与获得移植之间的关联。
我们使用了来自美国肾脏数据系统的数据（2000 年 1 月 1 日至 2007 年 9 月 24 日；n=619151）。我们使用 Cox 模型分析了两个结果：（i）在未列入名单的情况下被列入等待名单或移植的时间，以及（ii）在列入名单后的移植时间。根据不同的调整水平，我们开发了两个主要的 Cox 模型。
在调整了预先定义的潜在混杂因素的 Cox 模型中，与非糖尿病患者相比，糖尿病病史与移植机会减少相关 - 无论是在未列入名单的等待名单/移植方面（风险比，HR=0.80，p<0.001），还是在列入名单后的移植方面（HR=0.72，p<0.001）。在调整了 BMI 和合并症指数以及潜在混杂因素的 Cox 模型中，糖尿病病史与未列入名单的等待名单或移植的时间较短相关（HR=1.07，p<0.001），而列入名单后的移植时间没有显著差异（HR=1.01，p=0.42）。
我们证明了更高的合并症水平和更大的 BMI 调节了糖尿病与移植机会减少之间的关联。
