Glucose control is associated with patient and graft survival in diabetic patients after renal transplantation.

G. Heinze(1), C. Mitterbauer(2), A. Kainz(2,5), H. Regele(3), R. Kramar(4), C. Schwarz(2,5), W. Hörl(2), R. Oberbauer(2,4,5)

1- Core Unit of Medical Statistics and Informatics, Medical University of Vienna, Austria

2- Department of Nephrology, Medical University of Vienna, Austria

3- Department of Pathology, Medical University of Vienna, Austria

4- Austrian Dialysis and Transplant Registry, Hospital Wels, Austria

5- Department of Nephrology, KH Elisabethinen, Linz, Austria

 

// Tables
// Figures

Webtable 1:
Webtable 1:

Cox-regression: complete-cases-only analyses
Analysis is adjusted for: Number of antihypertensive drugs, cholesterol level, type of IS, year of TPL, MAP, donor age

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Webfigure 1:
Webfigure 1:

Glucose (medians/maxima per patient and year) (truncated at 1000 units).

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Webtable 2a:
Webtable 2a:

Complete-case-only analysis for Treatment comparison

a: Crude hazard ratios

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Webfigure 2:
Webfigure 2:

Hba1c (median per patient and year)

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Webtable 2b:
Webtable 2b:

Complete-case-only analysis for Treatment comparison

b: Adjusted hazard ratios (multivariable Cox model; adjusted for number of antihypertensive drugs, peripheral vascular disease, cholesterol level, maximal glucose level, type of immunosuppression, year of transplantation, diabetes duration, donor age; 65 deaths, 65 graft losses).

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Webtable 2c:
Webtable 2c:

Complete-case-only analysis for Treatment comparison

b: Adjusted hazard ratios (multivariable Cox model; adjusted for number of antihypertensive drugs, peripheral vascular disease, cholesterol level, maximal glucose level, type of immunosuppression, year of transplantation, diabetes duration, donor age; 65 deaths, 65 graft losses).

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Webtable 3:
Webtable 3:

Crude hazard ratios for treatment comparison.

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Webfigure 3a:
Webfigure 3a:

Nonlinear estimation of adjusted association of glucose control and mortality Nonlinear estimation was performed using restricted cubic splines with knots placed at the 5th, 35th, 65th and 95th percentiles of the empirical distribution of each parameter (median glucose per year, HbA1c, maximal glucose per year).

Patient survival
a: Neither mean glucose levels (mg/dl) nor mean HbA1c (%) predicted mortality. Solid line indicate the HR, dashed lines the 95%CI.

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Webfigure 3b:
Webfigure 3b:

Nonlinear estimation of adjusted association of glucose control and mortality Nonlinear estimation was performed using restricted cubic splines with knots placed at the 5th, 35th, 65th and 95th percentiles of the empirical distribution of each parameter (median glucose per year, HbA1c, maximal glucose per year).

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Webfigure 3c:
Webfigure 3c:

Nonlinear estimation of adjusted association of glucose control and mortality Nonlinear estimation was performed using restricted cubic splines with knots placed at the 5th, 35th, 65th and 95th percentiles of the empirical distribution of each parameter (median glucose per year, HbA1c, maximal glucose per year).

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Webfigure 3d:
Webfigure 3d:

Patient survival

d: The slope of this curve reaches a maximum at 207, i. e. at 207 there is maximal additional risk due to increase of maximal glucose by 1 unit

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Webtable 4:
Webtable 4:

Crude hazard ratios for treatment comparison.

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Webfigure 4a:
Webfigure 4a:

Nonlinear estimation of adjusted association of glucose control and mortality Nonlinear estimation was performed using restricted cubic splines with knots placed at the 5th, 35th, 65th and 95th percentiles of the empirical distribution of each parameter (median glucose per year, HbA1c, maximal glucose per year).

Functional graft survival
a: Solid line indicate the HR, dashed lines the 95%CI.

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Webfigure 4b:
Webfigure 4b:

Nonlinear estimation of adjusted association of glucose control and mortality Nonlinear estimation was performed using restricted cubic splines with knots placed at the 5th, 35th, 65th and 95th percentiles of the empirical distribution of each parameter (median glucose per year, HbA1c, maximal glucose per year).

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Webfigure 4c:
Webfigure 4c:

Functional graft survival

c: Maximal glucose per years, reference value 100

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Webfigure 4d:
Webfigure 4d:

Functional graft survival

d: Maximal glucose per years, reference value 180

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Webtable 5a:
Webtable 5a:

Assessment of model assumptions

a: Re-analysis for maximal glucose.

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Webfigure 5a:
Webfigure 5a:

Nonlinear estimation of adjusted association of glucose control and mortality Nonlinear estimation was performed using restricted cubic splines with knots placed at the 5th, 35th, 65th and 95th percentiles of the empirical distribution of each parameter (median glucose per year, HbA1c, maximal glucose per year).

Actual graft survival
a: Solid line indicate the HR, dashed lines the 95%CI.

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Webtable 5b:
Webtable 5b:

Assessment of model assumptions

b: Re-analysis for HbA1c.

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Webfigure 5b:
Webfigure 5b:

Nonlinear estimation of adjusted association of glucose control and mortality Nonlinear estimation was performed using restricted cubic splines with knots placed at the 5th, 35th, 65th and 95th percentiles of the empirical distribution of each parameter (median glucose per year, HbA1c, maximal glucose per year).

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Webfigure 5c:
Webfigure 5c:

Nonlinear estimation of adjusted association of glucose control and mortality Nonlinear estimation was performed using restricted cubic splines with knots placed at the 5th, 35th, 65th and 95th percentiles of the empirical distribution of each parameter (median glucose per year, HbA1c, maximal glucose per year).

c: Maximal glucose per years, reference value 100

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