А PREVALENCE AND RISK FACTORS FOR INSULIN RESISTANCE AND DYSGLYCEMIA AFTER KIDNEY TRANSPLANTATION IN PATIENTS ON CYCLOSPORINE-A BASED IMMUNOSUPPRESSION

Abstract

Glucose disorders and insulin resistance are major factors affecting cardiovascular morbidity after renal transplantation. We analyzed the prevalence of pre-diabetes, increased insulin resistance, the factors for their occurrence, as well as the consequences on graft function in kidney transplant patients who are on a cyclosporine-A based immunosuppressive protocol. 59 non-diabetic living donor kidney recipients were included in this cross-sectional and prospective study. All patients were on the same triple immunosuppressive therapy in maintenance doses. OGTT and indices of insulin resistance were analyzed at least 6 months after transplantation, as well as factors for their occurrence. According to the OGTT results, the patients were divided into two groups: a group with dysglycemia and a group of normoglycemic patients. Graft function was controlled after a period of follow-up. The prevalence of dysglycemia and insulin resistance was 33.9% (20/59) and 86.44% (51/59), respectively. In the group with dysglycemia, insulin resistance was more prevalent 95% (19/20), than beta-cell hypofunction 40% (8/20). The insulin resistance index in the dysglycemic group was significantly higher (3.139 ± 1.11) versus the normoglycemic group (2.264±1.00), p ˂0.01. The most significant risk factors for increased insulin resistance in the dysglycemic group were: shorter transplant period, higher doses of cyclosporin-A, postload insulin, and insulin secretion index. In this group of patients, a significant decrease in e-GFR was observed after an average of 18 months of follow-up. Insulin resistance is very prevalent after renal transplantation, and especially high in dysglycemic patients, and the associated risk factors are potentially modifiable. OGTT is an important diagnostic tool for assessing the prevalence of occult diabetes and insulin resistance, and its routine application may contribute to reducing their prevalence.