Obesity, adiponectin and inflammation as predictors of new-onset diabetes mellitus after kidney transplantation.
The high incidence of new-onset diabetes mellitus after transplantation (NODAT) suggests the need to find new factors to explain the pathogenesis. Our objectives were (1) to confirm that low levels of pre-transplant adiponectin are an independent risk factor for the development of NODAT in a larger transplanted population; (2) to analyze whether adiponectin is a better predictor of NODAT than other inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and pregnancy-associated plasma protein A (PAPP-A)) and (3) to assess the relationship between obesity, inflammatory markers and NODAT. One hundred ninety-nine non-diabetic patients (128 men; age: 53 +/- 11 years; body mass index (BMI) 24.98 +/- 3.76 kg/m2) were included. Pre-transplant plasma glucose, insulin, adiponectin, CRP, TNF-alpha, IL-6 and PAPP-A were measured. Forty-five patients developed NODAT. Patients with NODAT had a greater BMI (p = 0.005). Adiponectin was lower (p < 0.001) and CRP higher (p = 0.032) in patients with NODAT. Multivariate logistic regression and Cox analysis showed that the calcineurin inhibitor used, pre-transplant BMI and adiponectin were predictors of NODAT. ROC analysis showed that an adiponectin concentration of 11.4 microg/mL had a significant negative prediction for NODAT risk (sensitivity: 81% and specificity: 70%). Of the inflammatory markers studied, adiponectin proved to be an independent predictor of NODAT.
Bayés
B
B
Nephrology Department, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona (Barcelona), Spain. bbayes@teleline.es
Granada
M L
ML
Pastor
M C
MC
Lauzurica
R
R
Salinas
I
I
Sanmartí
A
A
Espinal
A
A
Serra
A
A
Navarro
M
M
Bonal
J
J
Romero
R
R
D052242:Adiponectin / Q000097:blood*; D000328:Adult; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity
D052242:Adiponectin