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Metabolic cardiovascular syndrome after renal transplantation
J Hjelmesaeth1, A Hartmann, K Midtvedt
1Department of Medicine, National Hospital, University of Oslo, Oslo, Norway.
Insights
Post-transplant glucose intolerance in kidney recipients is linked to cardiovascular disease risk factors. This metabolic abnormality suggests a post-transplant metabolic cardiovascular syndrome.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in renal transplant recipients.
- Traditional CVD risk factors are prevalent but do not fully explain the high CVD rates.
- The study investigates post-transplant glucose intolerance and its association with CVD risk factors.
Purpose of the Study:
- To determine if post-transplant glucose intolerance is associated with metabolic disturbances that increase cardiovascular disease risk.
- To explore the relationship between glucose metabolism and cardiovascular risk in kidney transplant patients.
Main Methods:
- Prospective examination of 173 renal transplant recipients 10 weeks post-transplant.
- Oral glucose tolerance test performed in 167 patients.
- Evaluation of cardiovascular risk factors through questionnaires, medical records, and blood tests.
Main Results:
- Glucose intolerance was observed in approximately 50% of recipients.
- Associated factors included age, family history of ischemic heart disease, acute rejection, higher triglycerides, apolipoprotein B, and 2-h insulin.
- Lower HDL cholesterol, higher triglycerides, apolipoprotein B, and 2-h insulin remained significant after adjusting for age and sex.
Conclusions:
- Post-transplant glucose intolerance at 10 weeks is linked to a cluster of cardiovascular risk factors.
- These findings suggest a post-transplant metabolic cardiovascular syndrome.
- Early identification of glucose intolerance may aid in managing CVD risk in transplant patients.
Background:
Cardiovascular disease (CVD) is the major cause of death in renal transplant recipients. Traditional risk factors like hypertension, dyslipidaemia and diabetes mellitus are common, but cannot completely account for the high prevalence of CVD in this population. The aim of the present study was to assess whether post-transplant glucose intolerance, defined as post-transplant diabetes mellitus, impaired glucose tolerance, or impaired fasting glucose, is associated with metabolic disturbances known to increase risk of cardiovascular disease, similar to what has been observed in the general population.
Methods:
One hundred and seventy-three consecutive patients were prospectively examined 10 weeks after transplantation. An oral glucose tolerance test was completed in 167 patients. Questionnaires, medical records, and the results of various blood tests were used to evaluate a number of known cardiovascular risk factors in all patients.
Results:
Glucose intolerance was present in about one-half the recipients and was associated with age, a positive family history of ischaemic heart disease, acute rejection, higher levels of serum triglycerides, apolipoprotein B and 2-h insulin, and lower levels of serum HDL cholesterol. After adjustment for age and sex, lower HDL cholesterol (P=0.005), higher serum triglycerides (P<0.001), apolipoprotein B (P=0.039) and 2-h insulin (P<0.001) were still associated with post-transplant glucose intolerance.
Conclusions:
Ten weeks after renal transplantation glucose intolerance is associated with a clustering of cardiovascular risk factors and metabolic abnormalities, consistent with a post-transplant metabolic cardiovascular syndrome.