Glucose tolerance before and after renal transplantation

• Published in: Nephrology, dialysis, transplantation Vol. 25; no. 3; pp. 985 - 992
• Main Authors: Bergrem, Henrik Andreas, Valderhaug, Tone Gretland, Hartmann, Anders, Bergrem, Harald, Hjelmesæth, Jøran, Jenssen, Trond
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-03-2010
• Subjects: Adult; Age Factors; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cohort Studies; Continental Population Groups; Diabetes Mellitus - epidemiology; Diabetes Mellitus - ethnology; Diabetes Mellitus - physiopathology; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerular Filtration Rate; Glucose Intolerance - ethnology; Glucose Intolerance - physiopathology; Glucose Tolerance Test; Humans; hyperglycaemia; Hyperglycemia - epidemiology; Hyperglycemia - ethnology; Hyperglycemia - physiopathology; Intensive care medicine; Kidney Transplantation - ethnology; Kidney Transplantation - physiology; Male; Medical sciences; Middle Aged; multiple imputation; oral glucose tolerance test; Predictive Value of Tests; Renal Insufficiency - ethnology; Renal Insufficiency - physiopathology; Renal Insufficiency - surgery; renal transplantation; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; urea; hyperglycaemia; multiple imputation; oral glucose tolerance test; renal transplantation; urea; Kidney disease; Urinary system disease; Hemodialysis; Oral administration; Glucose tolerance test; Glucose; Extrarenal dialysis; Urea; Renal failure
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfp566

Background. Renal insufficiency predisposes to insulin resistance, hyperparathyroidism and derangements in calcium phosphate and nitrogenous compound balance, leading to pre-transplant hyperglycaemia. These metabolic risk factors are not fully corrected after renal transplantation. The present study aimed to assess the role of pre-transplant glycaemia and the named metabolic risk factors in post-transplant hyperglycaemia [PHYG; impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes mellitus (DM)]. Methods. This is a retrospective cohort study involving 301 patients without pre-transplant DM. Measurements included a pre- and post-transplant oral glucose tolerance test (OGTT) as well as glomerular filtration rate (GFR), parathyroid hormone (PTH), phosphate, calcium and urea measured 10 weeks post-transplant. The risk of PHYG at 10 weeks post-transplant was analysed using multiple logistic regression. Results. Ninety-three patients (31%) had PHYG (two IFG, 52 IGT, 39 DM). Variables associated with PHYG included pre-transplant 2-h glycaemia [OR 1.26, 95% CI (1.09, 1.46)] and post-transplant urea levels [OR 1.14, 95% CI (1.02, 1.27)]. Older age, non-Caucasian ethnicity, previous transplants, ≥3 HLA class 1 mismatches and high prednisolone doses were likewise associated with an increased PHYG risk (all P < 0.05). Conclusions. Pre-transplant glycaemia and high post-transplant levels of urea were associated with a greater risk of PHYG. This seemed to be independent of GFR, PTH, phosphate, calcium and traditional risk factors such as age and glucocorticoid load.