NDT Advance Access originally published online on March 29, 2007
Nephrology Dialysis Transplantation 2007 22(7):1994-1999; doi:10.1093/ndt/gfm067
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Glycated haemoglobin levels are related to chronic subclinical inflammation in renal transplant recipients without pre-existing or new onset diabetes
1Research Unit, Hospital Universitario de Canarias, University of La Laguna, Tenerife, 2Instituto de Investigación Reina Sofía, 3Laboratory Section, Hospital Universitario de Canarias, La Laguna, 4Nephrology Section, Hospital Universitario Doctor Negrin, Las Palmas de Gran Canaria, 5Nephrology Section, Hospital Nuestra Señora de La Candelaria, Tenerife, 6Nephrology Section, Hospital Universitario Insular, Las Palmas de Gran Canaria and 7Hospital General de Lanzarote, Lanzarote, Spain
Correspondence and offprint requests to: Armando Torres, Nephrology Section and Research Unit, Hospital Universitario de Canarias, Ofra S/N, 38320, La Laguna, Tenerife, Spain. Email: atorres{at}ull.es
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Abstract |
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Background. C-reactive protein (CRP), a marker of chronic subclinical inflammation (CSI), is related to cardiovascular mortality in the general and renal transplant populations. In the general population, high CRP levels are associated with pre-diabetic glucose homeostasis alterations which may contribute to the proatherogenic effect of CSI.
Methods. We studied 134 consecutive renal transplant recipients without pre-existing or new onset diabetes. CRP, oral glucose tolerance test, insulin sensitivity and HbA1c were measured.
Results. Among CRP tertiles, fasting glucose and glucose after 120 min were not different. However, HbA1c was higher (4.9 ± 0.6; 5.2 ± 0.5; 5.4 ± 0.5; P = 0.005] and insulin sensitivity lower (McAuley index: 7.2 ± 2; 6.8 ± 2; 6.2 ± 1.3; P = 0.042) in the third CRP tertile. In addition, HDL-cholesterol was lower and triglycerides and body mass index (BMI) higher in the third tertile. Consequently, metabolic syndrome was more prevalent in the upper CRP tertiles [11 (25%); 19 (43%); 22 (50%); P = 0.01). In multivariate analyses, HbA1c was related to higher CRP levels (standardized ß coefficient = 0.21, P = 0.013), independently of BMI (standardized ß coefficient = 0.24, P = 0.005) and triglycerides (standardized ß coefficient = 0.18; P = 0.03).
Conclusions. Subclinical glucose homeostasis alterations are related to chronic inflammation in renal transplant recipients without pre-existing or new onset diabetes and may contribute to their high cardiovascular mortality.
Keywords: chronic subclinical inflammation; glycated haemoglobin; insulin resistance; new onset diabetes after transplantation (NODAT)
Received for publication: 12.11.06
Accepted in revised form: 19. 1.07