Dynamics of Glucose Metabolism After Kidney Transplantation

• Published in: Kidney & blood pressure research Vol. 42; no. 3; pp. 598 - 607
• Main Authors: Guthoff, Martina, Wagner, Robert, Weichbrodt, Karoline, Nadalin, Silvio, Königsrainer, Alfred, Häring, Hans-Ulrich, Fritsche, Andreas, Heyne, Nils
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2017; Karger Publishers
• Subjects: Blood Glucose - metabolism; Complications; Diabetes; Diabetes Complications; Diabetes mellitus; Diabetes Mellitus - diagnosis; Dynamics; Female; Fluxes; Glucose; Glucose metabolism; Glucose tolerance; Graft Survival; Hemoglobin; Humans; Immunological tolerance; Immunosuppression; Incidence; Intervention; Kidney diseases; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Kidneys; Longitudinal Studies; Male; Metabolism; Middle Aged; Mortality; Original Paper; Patients; Posttransplantation diabetes mellitus; Prediabetes; Prediabetic State - diagnosis; Prevalence; Random variables; Retrospective Studies; Risk analysis; Risk factors; Transplantation; Transplants & implants; Posttransplantation diabetes mellitus; Prediabetes; Dynamics; Risk factors; Kidney transplantation; Incidence
• DOI: 10.1159/000481375
• ISSN: 1420-4096

Background/Aims: Posttransplantation diabetes mellitus (PTDM) impacts patient and allograft survival after kidney transplantation. Prediabetes, which is an independent risk factor for PTDM, is modifiable also in a post-transplant setting. Understanding the risks and dynamics of impaired glucose metabolism after transplantation is a key component for targeted intervention. Methods: A retrospective chart analysis of all adult non-diabetic renal allograft recipients (n=251, 2007-2014) was performed. Longitudinal follow-up included fasting plasma glucose and HbA1c, as well as data on allograft function and immunosuppression at consecutive time points (months 3-6 to >5 years post transplantation). Results: Throughout follow-up, median prevalence of prediabetes and PTDM was 53.3 [52.4-55.7]% and 15.4 [15.0-16.5]%, respectively. Continuously high fluxes between states of glucose metabolism, with individual patients’ state deteriorating or improving over time, resulted in a high number of incident patients even long after transplantation. The greatest number of patients shifted between normal glucose tolerance and prediabetes, followed by those between prediabetes and PTDM. Conclusion: Prediabetes and PTDM are highly prevalent after kidney transplantation and incidences remain relevant throughout follow-up. Patient fluxes into and out of the prediabetic state show that glucose metabolism is highly dynamic after transplantation. This provides a continuous opportunity for intervention in an aim to reduce diabetes-associated complications.