Carotid atheromatosis in nondiabetic renal transplant recipients: the role of prediabetic glucose homeostasis alterations.
BACKGROUND
Prediabetic glucose homeostasis alterations are important cardiovascular risk factors but their role in renal transplant recipients (RTR) has not been established.


METHODS
In 172 RTRs without pretransplant or de novo diabetes, we measured carotid intima media thickness (c-IMT) and performed an oral glucose tolerance test (OGTT).


RESULTS
In multivariate analysis, age, hypertension and male sex were independently associated with a c-IMT in the third tertile. A significant interaction between gender and glucose homeostasis parameters was observed. Among male RTR, those with a c-IMT in the third tertile showed significantly higher plasma glucose and HbA1c levels (5+/-0.5% vs. 5.1+/-0.5% vs. 5.5+/-0.4%; P<0.01 tertile 3 vs. 2 or 1) than those in other tertiles. Insulin action parameters were not significantly different. The odds ratio of being in the higher c-IMT tertile was 2.9 (95% CI: 1.05-8.1) per each 1% increase of HbA1c. By contrast, glucose and HbA1c levels were not significantly different between c-IMT tertiles in female RTR. However, age-adjusted insulin levels after OGTT were higher (86+/-10 vs. 51.7+/-9.4; P=0.02) and the insulin sensitivity index lower (0.8+/-0.3 vs. 0.048+/-0.03; P=0.04) among females in the third tertile as compared to the first one.


CONCLUSIONS
Prediabetic glucose homeostasis alterations in RTRs are related to carotid atherosclerosis, although there may be gender differences in the underlying alteration.
Alvarez
Alejandra
A
Nephrology Section and Research Unit, Hospital Universitario de Canarias. University of La Laguna, Tenerife, Spain.
Fernandez
Julián
J
Porrini
Esteban
E
Delgado
Patricia
P
Pitti
Sergio
S
Vega
María José
MJ
González-Posada
José Manuel
JM
Rodríguez
Aurelio
A
Pérez
Lourdes
L
Marrero
Domingo
D
Luis
Desiré
D
Velázquez
Silvia
S
Hernández
Domingo
D
Salido
Eduardo
E
Torres
Armando
A
D000328:Adult; D050197:Atherosclerosis / Q000175:diagnosis / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000150:complications; D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases; D005260:Female; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology
D007166:Immunosuppressive Agents; D005947:Glucose