Glucose tolerance before and after renal transplantation.
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, >or=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.
Department of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. henrik.andreas.bergrem@rikshospitalet.no
Henrik Andreas
HA
Bergrem
Tone Gretland
TG
Valderhaug
Anders
A
Hartmann
Harald
H
Bergrem
Jøran
J
Hjelmesaeth
Trond
T
Jenssen
D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D018149:Glucose Intolerance / Q000208:ethnology / Q000503:physiopathology*; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000208:ethnology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000208:ethnology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D044469:Racial Groups; D051437:Renal Insufficiency / Q000208:ethnology / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors