Pretransplant evaluation and the risk of glucose metabolic alterations after renal transplantation: a prospective study

Autor: Arminda Fariña-Hernández, Domingo Marrero-Miranda, Estefania Perez-Carreño, Antonia De Vera-Gonzalez, Alejandra González, Cristian Acosta-Sorensen, Ana Elena Rodríguez-Rodríguez, Tatiana Collantes, Marta del Pino García, Ana Isabel Rodríguez-Muñoz, Carla Rodriguez-Alvarez, Antonio Rivero, Manuel Macía, Elena Teran, Nuria V Sanchez-Dorta, Lourdes Perez-Tamajón, Alejandra Alvarez-González, Ana González-Rinne, Aurelio Rodríguez-Hernández, Eduardo De Bonis-Redondo, Concepción Rodriguez-Adanero, Domingo Hernández, Esteban Porrini, Armando Torres
Rok vydání: 2022
Předmět:
Zdroj: Nephrology Dialysis Transplantation. 38:778-786
ISSN: 1460-2385
0931-0509
DOI: 10.1093/ndt/gfac256
Popis: Background Post-transplant prediabetes (PreDM) and diabetes (PTDM) are common and have an impact on cardiovascular events. We sought to investigate the pathogenesis and best approach for prediction. Methods We prospectively studied 115 waitlisted patients from a single center without manifest diabetes. An oral glucose tolerance test (OGTT) was performed yearly until transplantation and 12 months later. Insulin secretion, insulin sensitivity (IS) and disposition index (DI) were derived from the OGTT. Results PreDM and PTDM were observed in 27% and 28.6% of patients, respectively. Pretransplant age, body mass index (BMI), 120 min glucose, IS, DI, and prediabetes or undiagnosed diabetes were significantly associated with these alterations. In multivariate analysis, pretransplant age [odds ratio (OR) 1.5; 95% confidence interval (CI) 1.04–2.1], BMI (OR 1.16; 95% CI 1.04–1.3) and cumulative steroids (OR 1.5; 95% CI 1.02–2.2) were predictors of PreDM or PTDM. Receiver operating characteristic curve analysis showed that pretransplant BMI and 120 min glucose had the highest area under the curve (0.72; 95% CI 0.62–0.8; and 0.69; 95% CI 0.59–0.79, respectively). The highest discrimination cut-off for BMI (≥28.5 kg/m2) and 120 min glucose (≥123.5 mg/dL) yielded a similar number needed to diagnose (2.5). Conclusions PreDM or PTDM develops in waitlisted patients with an ineffective insulin secretion and BMI shows a similar diagnostic capacity to OGTT. Pretransplant interventions may reduce post-transplant glucose alterations.
Databáze: OpenAIRE
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