NDT Advance Access published online on April 20, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl754
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Insulin maintains plasma antioxidant capacity at an early phase of kidney transplantation
1Department of Nephrology and Internal Medicine, 2Department of Biochemistry, 3Department of Endocrinology and 4Department of Anaesthesiology, CHU Amiens, INSERM ERI-12 and Jules Verne University, Amiens, France
Correspondence and offprint requests to: Matthieu Monge, MD, Nephrology and Internal Medicine Department, CHU Amiens – Hôpital Sud, Avenue Laennec, 80054 Amiens, France. Email: mongematt{at}yahoo.fr
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Abstract |
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Background. Ischaemia-reperfusion and hyperglycaemia are two main sources of oxidative stress that plays an important role in the pathophysiology of tissue injury in transplant recipients. We hypothesized that controlling hyperglycaemia with insulin during the first hours following kidney transplantation could improve antioxidant defences and therefore decrease ischaemia-reperfusion-induced injury.
Method. We performed a prospective randomized study in non-diabetic dialysed patients receiving a first cadaveric renal allograft, and assigned them to receive either 200 g/day of glucose infusion (control group, n = 23) or the same glucose infusion and intravenous insulin to maintain blood glucose <10 mmol/l (insulin group, n = 20). Antioxidant defences were assessed by the plasma total radical-trapping antioxidant parameter (TRAP).
Results. TRAP values remained stable throughout the study in the Insulin group, whereas they decreased from admission to day 1 (–2.70 ± 0.16 vs –2.98 ± 0.26, P < 0.0001), and tended to retrieve the basal values at day 15 in the control group. TRAP values were significantly higher in the insulin group compared with the control group at days 1 (–2.80 ± 0.19 vs –2.98 ± 0.16, P < 0.05) and 4 (–2.80 ± 0.19 vs –2.95 ± 0.20, P < 0.05). No differences were found between the two groups on urinary malondialdehyde determination, two markers of oxidative damage, nor in graft function or patient outcome.
Conclusions. This is the first clinical trial to demonstrate improvement in insulin-induced antioxidant defences at the early stage of kidney transplantation. More extensive studies will tell if this strategy has beneficial impact in long-term graft outcome.
Keywords: insulin; ischemia-reperfusion injury; kidney transplantation; oxidative stress; reactive oxygen species; total radical-trapping antioxidant parameter (TRAP)
Received for publication: 23. 7.06
Accepted in revised form: 17.11.06