#2587 Survival and access to renal transplantation of patients with type 1 diabetes: a study from the REIN registry

Abstract Background and Aims One of the most severe complication of type 1 diabetes (D1) is renal injury which can lead to end stage renal disease. Even though improvement have been made to slow the progression of the renal disease, some of D1 patients still reach dialysis. Those patients seem to have more comorbidities and poor prognosis compare to patients without diabetes (D0) starting dialysis or patients with type 2 (D2) diabetes. Method The French Renal Epidemiology and Information Network (REIN) registry collects information on all patients starting dialysis in France. We used this cohort to explore survival and access to renal transplantation of D1 on dialysis patients compare to D0 and D2 patients, using Cox proportional hazard models and graphical representation of the variables to explore the pathway from type 1 diabetes to the outcomes of interest. We performed sensitivity analysis on the imputed base obtain by MICE (in order to reduce the influence of missing data) to compare HR. Results From January 1, 2010 to December 31,2016, 1596 D1 patients were compared to 39540 D0 patients and 28170 D2 patients. Excess in all-cause mortality rate were 1.26 [1.14-1.40] (p < 0.001) for D1 versus D0 and rises to 1.45 [1.32-1.59] (p < 0.001) when considering diabetes-related comorbidities on the pathway from diabetes to death. D1 had a poorer access to kidney transplantation (0.74 [0.66-0.82] p < 0.001) adjusting for non-diabetes-related comorbidities. Using the survival model to compare D1 and D2 on the imputed bases, we obtained an HR: 1.11; 95% CI: 1.01-1.21 p = 0.027, in favor of a worse survival of D1 patients in dialysis compare to D2 patients Conclusion These results confirm that D1 patients starting dialysis are severely ill and particular care need to be given to detect and so reduce diabetes-related comorbidities and increase access to kidney transplantation.