Pretransplant evaluation and the risk of glucose metabolic alterations after renal transplantation: a prospective study

Post-transplant prediabetes (PreDM) and diabetes (PTDM) are common and have an impact on cardiovascular events. We sought to investigate the pathogenesis and best approach for prediction. We prospectively studied 115 waitlisted patients from a single center without manifest diabetes. An oral glucose...

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Published in:	Nephrology, dialysis, transplantation Vol. 38; no. 3; pp. 778 - 786
Main Authors:	Fariña-Hernández, Arminda, Marrero-Miranda, Domingo, Perez-Carreño, Estefania, De Vera-Gonzalez, Antonia, González, Alejandra, Acosta-Sorensen, Cristian, Rodríguez-Rodríguez, Ana Elena, Collantes, Tatiana, García, Marta Del Pino, Rodríguez-Muñoz, Ana Isabel, Rodriguez-Alvarez, Carla, Rivero, Antonio, Macía, Manuel, Teran, Elena, Sanchez-Dorta, Nuria V, Perez-Tamajón, Lourdes, Alvarez-González, Alejandra, González-Rinne, Ana, Rodríguez-Hernández, Aurelio, De Bonis-Redondo, Eduardo, Rodriguez-Adanero, Concepción, Hernández, Domingo, Porrini, Esteban, Torres, Armando
Format:	Journal Article
Language:	English
Published:	England 28-02-2023
Subjects:	Blood Glucose - metabolism Diabetes Mellitus - etiology Glucose Humans Insulin Resistance Kidney Transplantation - adverse effects Prediabetic State - complications Prospective Studies insulin secretion insulin resistance post-transplant diabetes mellitus obesity
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Summary:	Post-transplant prediabetes (PreDM) and diabetes (PTDM) are common and have an impact on cardiovascular events. We sought to investigate the pathogenesis and best approach for prediction. We prospectively studied 115 waitlisted patients from a single center without manifest diabetes. An oral glucose tolerance test (OGTT) was performed yearly until transplantation and 12 months later. Insulin secretion, insulin sensitivity (IS) and disposition index (DI) were derived from the OGTT. PreDM and PTDM were observed in 27% and 28.6% of patients, respectively. Pretransplant age, body mass index (BMI), 120 min glucose, IS, DI, and prediabetes or undiagnosed diabetes were significantly associated with these alterations. In multivariate analysis, pretransplant age [odds ratio (OR) 1.5; 95% confidence interval (CI) 1.04-2.1], BMI (OR 1.16; 95% CI 1.04-1.3) and cumulative steroids (OR 1.5; 95% CI 1.02-2.2) were predictors of PreDM or PTDM. Receiver operating characteristic curve analysis showed that pretransplant BMI and 120 min glucose had the highest area under the curve (0.72; 95% CI 0.62-0.8; and 0.69; 95% CI 0.59-0.79, respectively). The highest discrimination cut-off for BMI (≥28.5 kg/m2) and 120 min glucose (≥123.5 mg/dL) yielded a similar number needed to diagnose (2.5). PreDM or PTDM develops in waitlisted patients with an ineffective insulin secretion and BMI shows a similar diagnostic capacity to OGTT. Pretransplant interventions may reduce post-transplant glucose alterations.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0931-0509 1460-2385
DOI:	10.1093/ndt/gfac256