| Abstract: | 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.New-onset diabetes after renal transplantation (NODAT) represents a serious metabolic complication with a negative impact on graft and patient survival, as well as on cardiovascular morbidity and mortality (1–5). Emerging information indicates that less severe glucose metabolism alterations (GMA), such as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), are also highly prevalent (6–10) and are associated with increased cardiovascular risk in the general population (11,12). In the renal transplant setting, Cosio et al. (13) reported that IFG was associated with a significantly higher incidence of posttransplantation cardiac events and peripheral vascular disease. In addition, an abnormal oral glucose tolerance test (OGTT) in stable renal transplant recipients is related to carotid atheromatosis (14), a surrogate marker of cardiovascular morbidity and mortality.Recently developed consensus guidelines have suggested that the diagnosis of GMA in renal transplant recipients should be based on regular screening of fasting blood glucose (1); however, other studies demonstrated that such an approach underestimated the true incidence of NODAT and ignored the important diagnosis of IGT, which can be made only with a simple and inexpensive OGTT (6–10). Single-center studies have reported that stable renal transplant recipients with IFG and/or IGT are older, exhibit higher body mass index and dyslipidemia, and more frequently are on β blockers (6–8); however, multicenter studies including a higher number of patients and reflecting different clinical practices may contribute to more accurate characterization of the clinical profile of recipients with GMA. Because these conditions are modifiable cardiovascular risk factors, providing the clinician with simple tools to suspect the condition may be helpful to indicate a more thorough investigation with OGTT and apply preventive interventions. The aims of this multicenter, cross-sectional study were to investigate the prevalence of GMA beyond 1 yr of transplantation and, in addition, the clinical profile and factors related to these conditions. |
