Factors associated with insulin resistance after long-term renal transplantation

Insulin resistance (IR) is an early and very strong predictor of posttransplantation diabetes mellitus as well as an important cardiovascular risk factor even in the absence of hyperglycemia. Patients after renal transplantation are insulin resistant compared with a control group with similar demographic characteristics. The aim of this study was to determine the frequency of IR in renal allograft patients without glucose disorders, to correlate IR indexes with the doses of immunosuppressive medications, and to examine other risk factors, such as age, obesity, and antihypertensive therapy used. One hundred six patients who received a kidney transplant at Baskent University Hospital between 1992 and 2006 were enrolled the study. IR was diagnosed by using homeostasis model assessment (HOMA); 53.8% of the patients (n=57) had IR. HOMA-IR was correlated with age, body mass index, and waist-hip ratio (P values .004, .001, and .000, respectively). In regression analysis, only waist-hip ratio was significantly associated with HOMA-IR. Our results indicate that abdominal waist-hip ratio is a major determinant of IR after renal transplantation. Even in the absence of hyperglycemia, renal transplant patients may have IR. If obesity is prevented, long-term patient and graft survival may be improved.