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Glucose tolerance before and after renal transplantation
Henrik Andreas Bergrem1, Tone Gretland Valderhaug, Anders Hartmann
1Department of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. henrik.andreas.bergrem@rikshospitalet.no
Summary
Pre-transplant hyperglycemia and elevated post-transplant urea levels increase the risk of post-transplant hyperglycemia (PHYG). These factors appear independent of kidney function and other metabolic derangements.
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Syndrome
Background:
- Renal insufficiency causes metabolic disturbances like insulin resistance and hyperparathyroidism, leading to pre-transplant hyperglycemia.
- These metabolic issues often persist post-renal transplantation, impacting patient outcomes.
- Post-transplant hyperglycemia (PHYG) encompasses impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus (DM).
Purpose of the Study:
- To investigate the association between pre-transplant glycemic status and metabolic risk factors with post-transplant hyperglycemia (PHYG).
- To evaluate the predictive role of pre-transplant hyperglycemia and specific metabolic parameters on the development of PHYG.
Main Methods:
- Retrospective cohort study of 301 patients without pre-transplant diabetes mellitus.
- Oral glucose tolerance tests (OGTT) were performed pre- and post-transplant.
- Post-transplant measurements included glomerular filtration rate (GFR), parathyroid hormone (PTH), phosphate, calcium, and urea levels at 10 weeks.
Main Results:
- 31% of patients developed PHYG (IFG, IGT, or DM).
- Pre-transplant 2-hour glucose levels (OR 1.26) and post-transplant urea levels (OR 1.14) were significantly associated with PHYG.
- Increased risk of PHYG was also linked to older age, non-Caucasian ethnicity, prior transplants, HLA mismatches, and higher prednisolone doses.
Conclusions:
- Elevated pre-transplant glucose levels and higher post-transplant urea are significant predictors of post-transplant hyperglycemia.
- These associations appear independent of renal function (GFR), PTH, calcium, phosphate, and traditional risk factors like age and steroid use.
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