Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Diabetes (DM) represents a global epidemic; it is the leading cause of ESRD in the US and a predominant etiology for kidney transplantation (KTX). New onset DM (NODAT) is also a common issue after KTX. The aim of this study was to quantify the impact of DM on healthcare utilization, including clinic visits, hospitalizations, total length of stay (LOS) and ED visits, in rates per patient year (PPY).
*Methods: This was a longitudinal cohort study of adult KTX recipients from 1/2017 to 2/2019. Pediatrics and non-KTX were excluded. Comprehensive baseline and clinical follow-up data were acquired through electronic and manual chart abstraction. Random intercept generalized linear mixed models with negative binomial distribution were utilized to assess the impact of DM on utilization, accounting for zero inflated data.
*Results: A total of 496 KTX recipients were included; 251 (50.6%) were controls (no DM), 212 (42.7%) had pre-KTX DM and 33 (6.7%) developed NODAT within 1 year of KTX. Due to the low NODAT cohort size, all DM patients were grouped for inferential statistical analysis. The DM cohort was older (49 vs 57 years, p<0.0001), had a higher BMI (28 vs 29, p=0.0214) and more marginal donors (KDPI 36.6 vs 39.8, p=0.0004). In the fully adjusted models, DM was associated with a 68% higher incident rate ratio (IRR) PPY for hospitalizations (1.68, p=0.0032), 35% higher clinic visit rate PPY (IRR 1.35, p<0.001), twice the LOS PPY (IRR 2.04, p=0.0012) and nearly three times the ED visit rate PPY (IRR 2.86, p<0.0001, see Figure below). The DM cohort had significantly more opportunistic infections (BK, CMV, EBV; 33% vs 44%, p=0.0152) and non-opportunistic infections (UTI, skin, bacteremia; 24% vs. 35%, p=0.0111). Leading causes of hospitalizations included infections, hyperglycemia, GI and cardiac. Leading symptoms for ED visits included SOB, hyperglycemia, pain and fever (see Table below).
*Conclusions: Patients with diabetes represent a challenging population to manage following KTX. These recipients utilize substantially more healthcare resources driven by higher rates of infections and cardiometabilic complications. Improved systems of care management are needed to optimize outcomes in this high-risk population.
To cite this abstract in AMA style:Taber D, Pilch N, Patel N, Perkins H, Foster K, Perez C, Bartlett F, Posadas A, Meadows H, Soliman K, Rao V, Casey M, Rohan V, McGillicuddy J, Nadig S, Dubay D. The Impact of Pre-Existing and New Onset Diabetes on Healthcare Utilization Following Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-pre-existing-and-new-onset-diabetes-on-healthcare-utilization-following-kidney-transplantation/. Accessed September 29, 2020.
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