Cardiovascular risk factors and cardiovascular disease in patients with type 1 diabetes and end-stage renal disease candidates for kidney-pancreas transplantation: trends from 1999 to 2017.

AIMS: To evaluate the changes in cardiovascular risk factors (CVRFs) and cardiovascular disease (CVD) in patients with type 1 diabetes (T1D) and end-stage renal disease (ESRD) who were candidates for kidney-pancreas transplantation (KPTx) from 1999 to 2017. METHODS: Patients with T1D referred for KPTx evaluation were included. The cohort was divided into five groups according to the year of evaluation (1999-2002, 2003-2006, 2007-2010, 2011-2014 and 2015-2017). The control of CVRFs and the prevalence of prior CVD were evaluated. RESULTS: We evaluated 360 patients (64.4% men, age 38.9+/-7.1 years). LDL-cholesterol <100 mg/dl increased from 22.7% to 76.9% (1999-2002 vs. 2015-2017; p<0.001), as did the use of statins (from 24.7% to 74.5%; p<0.001). Systolic blood pressure decreased from 138.8+/-27.6 to 125.1+/-27.9 mmHg (p=0.001) and current smokers from 48% to 25% (p=0.018). Intensive insulin treatment increased from 34.4% to 93.6% (p<0.001). Diabetes duration before the initiation of renal replacement therapy increased from 23+/-5.5 to 26.9+/-8.9 years (p=0.001). Overall, 30.3% had previous CVD, without significant changes over time (p=0.699), albeit patients were older and had longer diabetes duration. CONCLUSIONS: Patients with T1D and ESRD referred for KPTx have better control of CVRFs over time, which might lead to a decrease in cardiovascular events.