The Dynamics of Glucose Metabolism Under Calcineurin Inhibitors in the First Year After Renal Transplantation in Nonobese Patients

David‐Neto, Elias; Lemos, Francisco José Alves; Fadel, L. M.; Agena, Fabiana; Sato, Melissa Y; Coccuza, Christiano; Pereira, Lilian Elgalise Techio; Castro, Maria Cristina Ribeiro de; Lando, Valeria S; Nahas, William C.; Ianhez, L E

doi:10.1097/01.tp.0000267647.03550.22

Cited by 51 publications

(24 citation statements)

References 23 publications

(24 reference statements)

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“…In addition, these abnormalities, along with a more common diagnosis of IFG, were already detected at 3 mo, persisting during the first posttransplantation year (Table 2), and may have contributed to the higher rate of posttransplantation cardiovascular events in this group (Table 1). A similar observation was reported by Cosio et al (13), who showed that recipients with NODAT or IFG at 1 yr exhibited higher fasting glucose levels from the first month after transplantation; therefore, these findings suggest that an OGTT may be especially indicated in recipients who have hypertriglyceridemia and/or IFG by the end of the third month after transplantation (10).…”

Section: Discussionsupporting

confidence: 71%

Unmasking Glucose Metabolism Alterations in Stable Renal Transplant Recipients

Delgado¹,

Dı́az²,

Silva³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: Emerging information indicates that glucose metabolism alterations are common after renal transplantation and are associated with carotid atheromatosis. The aims of this study were to investigate the prevalence of different glucose metabolism alterations in stable recipients as well as the factors related to the condition.Design, setting, participants, & measurements: A multicenter, cross-sectional study was conducted of 374 renal transplant recipients without pre-or posttransplantation diabetes. A standard 75-g oral glucose tolerance test was performed.Results: Glucose metabolism alterations were present in 119 (31.8%) recipients: 92 (24.6%) with an abnormal oral glucose tolerance test and 27 (7.2%) with isolated impaired fasting glucose. The most common disorder was impaired glucose tolerance (17.9%), and an abnormal oral glucose tolerance test was observed for 21.5% of recipients with a normal fasting glucose. By multivariate analysis, age, prednisone dosage, triglyceride/high-density lipoprotein cholesterol ratio, and ␤ blocker use were shown to be factors related to glucose metabolism alterations. Remarkably, triglyceride levels, triglyceride/high-density lipoprotein cholesterol ratio, and the proportion of recipients with impaired fasting glucose were already higher throughout the first posttransplantation year in recipients with a current glucose metabolism alteration as compared with those without the condition.Conclusions: Glucose metabolism alterations are common in stable renal transplant recipients, and an oral glucose tolerance test is required for its detection. They are associated with a worse metabolic profile, which is already present during the first posttransplantation year. These findings may help planning strategies for early detection and intervention.

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Section: Discussionsupporting

confidence: 71%

Unmasking Glucose Metabolism Alterations in Stable Renal Transplant Recipients

Delgado¹,

Dı́az²,

Silva³

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…As a result, we labelled as diabetic even those patients who had a FPG ≥ 7.0 mmol/l but did not require pharmacological therapy for diabetes, unlike other studies. Furthermore, the mean age of recipients in this study (48 years) was higher than that reported in other studies (means ranging from 39 to 46.5), as was the BMI (mean 26.2 in this study compared to 23.5 to 25.6 in others) . Higher age and BMI may account for the higher incidence of NODAT in this study.…”

Section: Discussioncontrasting

confidence: 69%

Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation

et al. 2012

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SummaryNew-onset diabetes mellitus (NODAT) is a serious complication following renal transplantation. In this cohort study, we studied 118 nondiabetic renal transplant recipients to examine whether indices of insulin resistance and secretion calculated before transplantation and at 3 months post-transplantation are associated with the development of NODAT within 1 year. We also analysed the long-term impact of early diagnosed NODAT. Insulin indices were calculated using homeostasis model assessment (HOMA) and McAuley's Index. NODAT was diagnosed using fasting plasma glucose. Median follow-up was 11 years. The cumulative incidence of NODAT at 1 year was 37%. By logistic regression, recipient age (per year) was the only significant pretransplant predictor of NODAT (OR 1.04, CI 1.009-1.072), while age (OR 1.04, CI 1.005-1.084) and impaired fasting glucose (OR 2.97, CI 1.009-8.733) were significant predictors at 3 months. Pretransplant and 3-month insulin resistance and secretion indices did not predict NODAT. All-cause mortality was significantly higher in recipients developing NODAT within 1 year compared with those remaining nondiabetic (44% vs. 22%, logrank P = 0.008). By Cox's regression analysis, age (HR 1.075, CI 1.042-1.110), 1-year creatinine (HR 1.007, CI 1.004-1.010) and NODAT within 3 months (HR 2.4, CI 1.2-4.9) were independent predictors of death. In conclusion, NODAT developing early after renal transplantation was associated with poor long-term patient survival. Insulin indices calculated pretransplantation using HOMA and McAuley's Index did not predict NODAT.

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“…The proportion of patients who developed NODM during standard-dose treatment was comparable with the Tac arm of a recent 6-month study which used a similar definition for NODM [28]. It has been reported that patients with high trough levels of Tac early after transplantation are prone to develop glycemic disorders and that the diabetogenic effect of Tac can be ameliorated by reducing the dose of Tac [33–35]. …”

Section: Discussionmentioning

confidence: 76%

Renal Function and NODM inDe NovoRenal Transplant Recipients Treated with Standard and Reduced Levels of Tacrolimus in Combination with EC-MPS

Chan

Andrés²,

Bunnapradist³

et al. 2012

Journal of Transplantation

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Information is lacking concerning concomitant administration of enteric-coated mycophenolate sodium with tacrolimus (EC-MPS+Tac) in renal transplant recipients (RTxR). In this 6-month, prospective, open-label, multicenter study, de novo RTxR were randomized (1 : 1) to low-dose (LD) or standard-dose (SD) Tac with basiliximab, EC-MPS 720 mg bid, and steroids. Primary objective was to compare renal function at 6-month posttransplantation. Secondary objectives were to compare the incidences of biopsy-proven acute rejection (BPAR), graft loss and death, and new-onset diabetes mellitus (NODM). 292 patients (LD n = 151, SD n = 141) were included. Mean Tac levels were at the low end of the target range in standard-exposure patients (SD, n = 141) and exceeded target range in low-exposure patients (LD = 151) throughout the study. There was no significant difference in mean glomerular filtration rate (GFR) between treatments (ITT-population: 63.6 versus 61.0 mL/min). Incidence of BPAR was similar (10.6% versus 9.9%). NODM was significantly less frequent in LD Tac (17% versus 31%; P = 0.02); other adverse effects (AEs) were comparable. EC-MPS+Tac (LD/SD) was efficacious and well tolerated with well-preserved renal function. No renal function benefits were demonstrated, possibly related to poor adherence to reduced Tac exposure.

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The Dynamics of Glucose Metabolism Under Calcineurin Inhibitors in the First Year After Renal Transplantation in Nonobese Patients

Abstract: This study shows the need to perform an oral GTT at 60 days and at the end of the first year of renal transplantation to adequately diagnose impaired glucose metabolism.

Cited by 51 publications

References 23 publications

Unmasking Glucose Metabolism Alterations in Stable Renal Transplant Recipients

Unmasking Glucose Metabolism Alterations in Stable Renal Transplant Recipients

Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation

Renal Function and NODM inDe NovoRenal Transplant Recipients Treated with Standard and Reduced Levels of Tacrolimus in Combination with EC-MPS

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