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Unmasking Glucose Metabolism Alterations in Stable Renal Transplant Recipients: A Multicenter Study

Patricia Delgado^*, Juan Manuel Diaz, Irene Silva, José M. Osorio, Antonio Osuna, Beatriz Bayés, Ricardo Lauzurica, Edgar Arellano^||, Jose Maria Campistol^||, Rosa Dominguez^¶, Carlos Gómez-Alamillo^¶, Meritxell Ibernon^**, Francisco Moreso^**, Rocio Benitez, Ildefonso Lampreave, Esteban Porrini^*, and Armando Torres^*

^* Research Unit and Nephrology Section, Hospital Universitario de Canarias, University of La Laguna (Tenerife), Instituto Reina Sofía de Investigación Nefrológica, Madrid, Nephrology Section, Fundación Puigvert, Barcelona, Nephrology Section, Hospital Nuestra Señora Virgen de las Nieves, Granada, Nephrology Section, Hospital Germans Trias y Puyol, Badalona, ^|| Nephrology Section, Hospital Clinic, Barcelona, ^¶ Nephrology Section, Hospital Universitario Marqués de Valdecilla, Santander, ^** Nephrology Section, Hospital de Bellvitge, Hospitalet del Llobregat, Barcelona, and Nephrology Section, Hospital de Cruces, Bilbao, Spain

Correspondence: Dr. Armando Torres, Nephrology Section and Research Unit, Hospital Universitario de Canarias, Ofra S/N, 38320, La Laguna, Tenerife, Spain. Phone: 34-922678380; Fax: 34-922647112; E-mail: atorres{at}ull.es

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 β 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.