Insulin Resistance After Renal Transplantation
Impact of immunosuppressive and antihypertensive therapy
- Jøran Hjelmesæth, MD1,
- Karsten Midtvedt, MD, PHD2,
- Trond Jenssen, MD, PHD2 and
- Anders Hartmann, MD, PHD2
- 1Department of Medicine, Vestfold Central Hospital, Tønsberg, Norway
- 2Department of Medicine, Section of Nephrology, Rikshospitalet, University of Oslo, Oslo, Norway
Abstract
OBJECTIVE—The purpose of the present study was to validate various surrogate estimates of insulin sensitivity (IS) in a renal transplant population and to assess the influence of immunosuppressive and antihypertensive therapy on insulin resistance (IR) after renal transplantation.
RESEARCH DESIGN AND METHODS—A total of 167 consecutive renal transplant recipients without previously known diabetes underwent a 75-g oral glucose tolerance test (OGTT) 3 months after renal transplantation. A total of 43 patients also underwent a euglycemic-hyperinsulinemic glucose clamp study. Six OGTT-derived IS indexes were validated against the euglycemic-hyperinsulinemic glucose clamp–derived IS index (ISICLAMP).
RESULTS—The OGTT-derived ISITX correlated closely with the ISICLAMP (r = 0.58, P < 0.001). The other surrogate estimates of IS were also significantly but less well correlated with the ISICLAMP (Spearman’s correlation; r = −0.45 to 0.41, P = 0.003–0.050). In the univariate model, BMI, daily prednisolone dose, creatinine clearance, hypertension, number of antihypertensive agents, and use of diuretics or β-blockers were negatively associated with ISITX (P < 0.05). After multiple regression analysis, BMI (P < 0.001), daily prednisolone dose (P < 0.001), cytomegalovirus infection (P = 0.030), and triglycerides (P = 0.034) were shown to be independent predictors of posttransplant IR.
CONCLUSIONS—The OGTT-derived ISITX may be a useful estimate of IS in Caucasian renal transplant recipients. Increasing daily prednisolone dose is an independent predictor of IR after renal transplantation. Hypertension and the use of β-blockers and diuretics may also deteriorate IR in this group of patients.
- ACE, angiotensin-converting enzyme
- CMV, cytomegalovirus
- CsA, cyclosporin A
- IFG, impaired fasting glucose
- IGT, impaired glucose tolerance
- IR, insulin resistance
- IRI, insulin resistance index
- IS, insulin sensitivity
- ISI, insulin sensitivity index
- NGT, normal glucose tolerance
- OGTT, oral glucose tolerance test
- PTDM, posttransplant diabetes mellitus
Footnotes
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Address correspondence and reprint requests to Jøran Hjelmesæth, MD, Department of Medicine, Vestfold Central Hospital, Boks 2168, 3103 Tønsberg, Norway. E-mail: joran{at}online.no.
Received for publication 22 March 2001 and accepted in revised form 4 September 2001.
Jøran Hjelmesæth has received educational grants from the Research Council of Norway and from “Vårmøtefondet” Vestfold Central Hospital.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
