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Long-Term Progression of Abnormal Glucose Tolerance and Its Relationship With the Metabolic Syndrome After Kidney Transplantation

Nagaraja, Pramod1,3; Sharif, Adnan2; Ravindran, Vinod1; Baboolal, Keshwar1

doi: 10.1097/01.tp.0000438202.11971.2e
Clinical and Translational Research

Background: Metabolic syndrome (MS) diagnosed early after kidney transplantation is a risk factor for developing new-onset diabetes. The aim of this study was to examine whether glucose intolerance and MS identified late after transplantation influence the progression of glycemic abnormalities in kidney transplant recipients.

Methods: This is a retrospective study in which 76 non-diabetic renal transplant recipients underwent oral glucose tolerance tests (OGTT) in 2005 to 2006 (baseline) and then in 2011 to 2012 (follow-up). MS was identified using the International Diabetes Federation criteria and OGTT was interpreted according to the WHO classification.

Results: At follow-up, median time from transplantation was 11.1 years (range 6.2–23.8). Mean 0-hour and 2-hour plasma glucose levels were significantly higher at follow-up compared to baseline (5.7±0.7 vs. 5.9±0.9 mmol/L, P=0.03 and 6.7±1.9 vs. 7.5±2.8 mmol/L, P=0.03, respectively). The proportion of patients with an abnormal OGTT increased from 42% at baseline to 61% at follow-up (P=0.007). Patients with MS were more likely to progress to a higher degree of glucose intolerance compared to those without MS (58% vs. 27%, P=0.01). On multivariable logistic regression adjusted for age and gender, MS was significantly associated with the progression of glucose intolerance (OR 3.5, CI 1.2–9.9, P=0.01), as was a fasting glucose greater than 5.6 mmol/L (OR 4.8, CI 1.6–14.8, P=0.006).

Conclusion: MS is a risk factor for the progression of glucose intolerance in renal transplant recipients in the late posttransplant period. Therefore, MS has to be considered in tandem with OGTT results to assess cardiovascular risk.

1 Directorate of Nephrology and Transplantation, University Hospital of Wales, Cardiff, UK.

2 Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, UK.

3 Address correspondence to: Pramod Nagaraja, M.D., Directorate of Nephrology and Transplantation, University Hospital of Wales, Cardiff CF14 4XW, UK.

The authors declare no funding or conflicts of interest.

E-mail: npramod@doctors.net.uk

P.N. participated in designing and performing the research, analyzing the data, and writing the article. A.S. participated in designing and performing the research, and analyzing the data. V.R. participated in designing the research, analyzing the data, and writing the article. K.B. participated in designing and performing the research, analyzing the data, and writing the article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Received 4 February 2013. Revision requested 25 March 2013.

Accepted 24 September 2013.

Accepted January 7, 2014

© 2014 by Lippincott Williams & Wilkins