Dr MINA KHAIR1,2, Dr DHARMENAAN PALAMUTHUSINGAM1,2,3, Prof CARMEL M. HAWLEY2,4,5, Ms ELAINE M. PASCOE6, Prof DAVID W. JOHNSON4,5,7, Prof STEPHEN MCDONALD8,9,10, Prof NEIL BOUDVILLE11,12, Prof MATTHEW D. JOSE13,14, Assoc Prof GIRISH TALAULIKAR15,16, Dr MAGID FAHIM2,17, Dr NICK CROSS18,19
1Metro North Kidney Service, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 2Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Australia, 3School of Medicine, Griffith University, Southport, Brisbane, Australia, 4Metro South Kidney and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, Australia, 5Australasian Kidney Trials Network (AKTN), University of Queensland, Australia, Brisbane, Australia, 6Centre for Health Services Research, University of Queensland, St Lucia, Brisbane, Australia, 7Translational Research Institute, Brisbane, Australia, 8Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 9Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 10Adelaide Medical School, The University of Adelaide, Adelaide, Australia, 11Faculty of Medicine, University of Western Australia, Perth, Australia, 12Sir Charles Gairdner Hospital, Nedlands, Australia, 13Department of Nephrology, Royal Hobart Hospital, Hobart, Australia, 14School of Medicine, University of Tasmania, Hobart, Australia, 15Renal Services, ACT Health, , Australia, 16School of Medicine, Australian National University (ANU), , Australia, 17Metro North Health Service, Herston, Australia, 18Department of Nephrology, Te Whatu Ora Waitaha, Canterbury, New Zealand, 19Christchurch Hospital, Christchurch, New Zealand
Biography:
Mina is currently a third year Basic Physician Trainee working in Queensland on the Metro North network, at the Royal Brisbane and Women’s Hospital.
Aim:
To determine differences in 30-day mortality, cardiac and infective complications between insulin-treated and non-insulin treated diabetes mellitus (DM) in patients receiving chronic kidney-replacement therapy (KRT) following abdominal surgery.
Background:
DM is associated with increased postoperative complications. However, the additional impact of insulin treatment in patients receiving chronic KRT remains unknown.
Methods:
This bi-national data linkage study of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA; 2000–2015) identified adults with DM on chronic KRT who underwent abdominal surgery. Patients were categorised as insulin-treated (IT) or non-insulin-treated (NIT). Only the first surgery for each person was used in the analysis. Multivariable logistic regression adjusted for age, sex, body-mass index, dialysis vintage, modality, emergency admission and prior ischaemic heart disease was utilised. Key outcomes were 30-day mortality, cardiac events and infections.
Results:
Among 3,134 procedures (1,181 IT; 1,953 NIT), IT patients were younger (median: 60 vs 63 years, p<0.001) and 22% had type-1 diabetes. KRT modality distribution amongst both groups was similar. Thirty-day mortality did not differ between groups (IT vs NIT: 8.6% vs. 10.0%, aOR:1.04, 95%CI 0.79–1.37, p=0.752). Cardiac complications were more frequent in IT patients (aOR:1.40, 1.10–1.80, p=0.007). When stratified by KRT modality, similar relationships were observed among dialysis (aOR:1.38, 1.05–1.81, p=0.019) and transplant recipients (aOR:2.02, 1.00–4.10, p=0.051). Infective complications were significantly elevated in IT transplant recipients (aOR:1.76, 1.06–2.90, p=0.028), but not in IT patients receiving dialysis (aOR:1.05, 0.87–1.28, p=0.605).
Conclusions:
Insulin treatment was not associated with early postoperative mortality in patients with diabetes receiving KRT. However, it was associated with increased postoperative cardiac and infective complications, particularly among IT kidney transplant recipients. These findings underscore the need for tailored perioperative management.
Presentation Slides PDF – Click Here