title: Hyperinsulinemia and hyperfiltration in renal transplantation.
abstract: BACKGROUND
  Insulin-resistance hyperinsulinemia is a novel risk factor for renal disease in the general population. Glomerular hyperfiltration has been proposed as an early consequence of hyperinsulinemia.
  
  
  METHODS
  In this multicenter cohort study, we analyzed 202 patients without diabetes before or after renal transplantation during the first posttransplant year. Insulin was measured at 3 and 12 months. The majority of patients (91%) were on calcineurin inhibitors. Patients were classified as with persistent normo or hyperinsulinemia when situated below or above the median value of insulin (3 months: 9 muU/mL; 12 months: 8.74 muU/mL) at both periods. The 3 to 12 months percent change in calculated creatinine clearance (3-12 months DeltaCrCL) was calculated.
  
  
  RESULTS
  Patients with persistent hyperinsulinemia showed a higher increase in 3 to 12 months DeltaCrCL compared with those with persistent normoinsulinemia (12% [-20/40] vs. -0.03% [-12/18], P=0.035). We performed a multivariate linear regression analysis with the 3 to 12 months DeltaCrCL as the dependent variable and different factors that may induce hyperfiltration, including persistent hyperinsulinemia, as covariates. Persistent hyperinsulinemia was a risk factor for increased CrCL (beta 0.09, 95% CI 0.07/0.12, P=0.035).
  
  
  CONCLUSIONS
  In nondiabetic recipients during the first posttransplant year, hyperinsulinemia induced increments in CrCL. As this may herald future renal dysfunction, hyperinsulinemia should not be ignored as a potential target in this population.
authors.affiliation: Research Unit, Hospital Universitario de Canarias, La Laguna, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Porrini
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bayes
authors.forename: Juan M
authors.initials: JM
authors.lastname: Diaz
authors.forename: Meritxell
authors.initials: M
authors.lastname: Ibernon
authors.forename: Rocio
authors.initials: R
authors.lastname: Benitez
authors.forename: Rosa
authors.initials: R
authors.lastname: Domínguez
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Moreno
authors.forename: Patricia
authors.initials: P
authors.lastname: Delgado
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lauzurica
authors.forename: Irene
authors.initials: I
authors.lastname: Silva
authors.forename: Francisco
authors.initials: F
authors.lastname: Moreso
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Lampreabe
authors.forename: Manuel
authors.initials: M
authors.lastname: Arias
authors.forename: Antonio
authors.initials: A
authors.lastname: Osuna
authors.forename: Armando
authors.initials: A
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016030:Kidney Transplantation / Q000009:adverse effects*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors
chemical_list: D007328:Insulin; D003404:Creatinine