Glucose tolerance before and after renal transplantation
Background. Renal insufficiency predisposes to insulin resistance, hyperparathyroidism and derangements in calcium phosphate and nitrogenous compound balance, leading to pre-transplant hyperglycaemia. These metabolic risk factors are not fully corrected after renal transplantation. The present study...
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| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2010-03, Vol.25 (3), p.985-992 |
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| creator | Bergrem, Henrik Andreas Valderhaug, Tone Gretland Hartmann, Anders Bergrem, Harald Hjelmesæth, Jøran Jenssen, Trond |
| description | Background. Renal insufficiency predisposes to insulin resistance, hyperparathyroidism and derangements in calcium phosphate and nitrogenous compound balance, leading to pre-transplant hyperglycaemia. These metabolic risk factors are not fully corrected after renal transplantation. The present study aimed to assess the role of pre-transplant glycaemia and the named metabolic risk factors in post-transplant hyperglycaemia [PHYG; impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes mellitus (DM)]. Methods. This is a retrospective cohort study involving 301 patients without pre-transplant DM. Measurements included a pre- and post-transplant oral glucose tolerance test (OGTT) as well as glomerular filtration rate (GFR), parathyroid hormone (PTH), phosphate, calcium and urea measured 10 weeks post-transplant. The risk of PHYG at 10 weeks post-transplant was analysed using multiple logistic regression. Results. Ninety-three patients (31%) had PHYG (two IFG, 52 IGT, 39 DM). Variables associated with PHYG included pre-transplant 2-h glycaemia [OR 1.26, 95% CI (1.09, 1.46)] and post-transplant urea levels [OR 1.14, 95% CI (1.02, 1.27)]. Older age, non-Caucasian ethnicity, previous transplants, ≥3 HLA class 1 mismatches and high prednisolone doses were likewise associated with an increased PHYG risk (all P < 0.05). Conclusions. Pre-transplant glycaemia and high post-transplant levels of urea were associated with a greater risk of PHYG. This seemed to be independent of GFR, PTH, phosphate, calcium and traditional risk factors such as age and glucocorticoid load. |
| doi_str_mv | 10.1093/ndt/gfp566 |
| format | Article |
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Renal insufficiency predisposes to insulin resistance, hyperparathyroidism and derangements in calcium phosphate and nitrogenous compound balance, leading to pre-transplant hyperglycaemia. These metabolic risk factors are not fully corrected after renal transplantation. The present study aimed to assess the role of pre-transplant glycaemia and the named metabolic risk factors in post-transplant hyperglycaemia [PHYG; impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes mellitus (DM)]. Methods. This is a retrospective cohort study involving 301 patients without pre-transplant DM. Measurements included a pre- and post-transplant oral glucose tolerance test (OGTT) as well as glomerular filtration rate (GFR), parathyroid hormone (PTH), phosphate, calcium and urea measured 10 weeks post-transplant. The risk of PHYG at 10 weeks post-transplant was analysed using multiple logistic regression. Results. Ninety-three patients (31%) had PHYG (two IFG, 52 IGT, 39 DM). Variables associated with PHYG included pre-transplant 2-h glycaemia [OR 1.26, 95% CI (1.09, 1.46)] and post-transplant urea levels [OR 1.14, 95% CI (1.02, 1.27)]. Older age, non-Caucasian ethnicity, previous transplants, ≥3 HLA class 1 mismatches and high prednisolone doses were likewise associated with an increased PHYG risk (all P < 0.05). Conclusions. Pre-transplant glycaemia and high post-transplant levels of urea were associated with a greater risk of PHYG. This seemed to be independent of GFR, PTH, phosphate, calcium and traditional risk factors such as age and glucocorticoid load.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfp566</identifier><identifier>PMID: 19854851</identifier><identifier>CODEN: NDTREA</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Age Factors ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cohort Studies ; Continental Population Groups ; Diabetes Mellitus - epidemiology ; Diabetes Mellitus - ethnology ; Diabetes Mellitus - physiopathology ; Emergency and intensive care: renal failure. Dialysis management ; Female ; Glomerular Filtration Rate ; Glucose Intolerance - ethnology ; Glucose Intolerance - physiopathology ; Glucose Tolerance Test ; Humans ; hyperglycaemia ; Hyperglycemia - epidemiology ; Hyperglycemia - ethnology ; Hyperglycemia - physiopathology ; Intensive care medicine ; Kidney Transplantation - ethnology ; Kidney Transplantation - physiology ; Male ; Medical sciences ; Middle Aged ; multiple imputation ; oral glucose tolerance test ; Predictive Value of Tests ; Renal Insufficiency - ethnology ; Renal Insufficiency - physiopathology ; Renal Insufficiency - surgery ; renal transplantation ; Retrospective Studies ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; urea</subject><ispartof>Nephrology, dialysis, transplantation, 2010-03, Vol.25 (3), p.985-992</ispartof><rights>Oxford University Press © The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.For Permissions, please e-mail: journals.permissions@oxfordjournals.org 2009</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-136b866d958c9205504fcf7ddbc0aef5bc3602cddc44ffe3f9d4d08c9a0354b93</citedby><cites>FETCH-LOGICAL-c518t-136b866d958c9205504fcf7ddbc0aef5bc3602cddc44ffe3f9d4d08c9a0354b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22680587$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19854851$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bergrem, Henrik Andreas</creatorcontrib><creatorcontrib>Valderhaug, Tone Gretland</creatorcontrib><creatorcontrib>Hartmann, Anders</creatorcontrib><creatorcontrib>Bergrem, Harald</creatorcontrib><creatorcontrib>Hjelmesæth, Jøran</creatorcontrib><creatorcontrib>Jenssen, Trond</creatorcontrib><title>Glucose tolerance before and after renal transplantation</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><addtitle>Nephrol Dial Transplant</addtitle><description>Background. Renal insufficiency predisposes to insulin resistance, hyperparathyroidism and derangements in calcium phosphate and nitrogenous compound balance, leading to pre-transplant hyperglycaemia. These metabolic risk factors are not fully corrected after renal transplantation. The present study aimed to assess the role of pre-transplant glycaemia and the named metabolic risk factors in post-transplant hyperglycaemia [PHYG; impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes mellitus (DM)]. Methods. This is a retrospective cohort study involving 301 patients without pre-transplant DM. Measurements included a pre- and post-transplant oral glucose tolerance test (OGTT) as well as glomerular filtration rate (GFR), parathyroid hormone (PTH), phosphate, calcium and urea measured 10 weeks post-transplant. The risk of PHYG at 10 weeks post-transplant was analysed using multiple logistic regression. Results. Ninety-three patients (31%) had PHYG (two IFG, 52 IGT, 39 DM). Variables associated with PHYG included pre-transplant 2-h glycaemia [OR 1.26, 95% CI (1.09, 1.46)] and post-transplant urea levels [OR 1.14, 95% CI (1.02, 1.27)]. Older age, non-Caucasian ethnicity, previous transplants, ≥3 HLA class 1 mismatches and high prednisolone doses were likewise associated with an increased PHYG risk (all P < 0.05). Conclusions. Pre-transplant glycaemia and high post-transplant levels of urea were associated with a greater risk of PHYG. This seemed to be independent of GFR, PTH, phosphate, calcium and traditional risk factors such as age and glucocorticoid load.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Continental Population Groups</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diabetes Mellitus - ethnology</subject><subject>Diabetes Mellitus - physiopathology</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Glucose Intolerance - ethnology</subject><subject>Glucose Intolerance - physiopathology</subject><subject>Glucose Tolerance Test</subject><subject>Humans</subject><subject>hyperglycaemia</subject><subject>Hyperglycemia - epidemiology</subject><subject>Hyperglycemia - ethnology</subject><subject>Hyperglycemia - physiopathology</subject><subject>Intensive care medicine</subject><subject>Kidney Transplantation - ethnology</subject><subject>Kidney Transplantation - physiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>multiple imputation</subject><subject>oral glucose tolerance test</subject><subject>Predictive Value of Tests</subject><subject>Renal Insufficiency - ethnology</subject><subject>Renal Insufficiency - physiopathology</subject><subject>Renal Insufficiency - surgery</subject><subject>renal transplantation</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>urea</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0E1LwzAYwPEgipvTix9AehFBqEualyZHmbqJUw8qyC4hzYtUu7YmKei3t2PD3fSUw_PjSfIH4BjBCwQFHtcmjt9cSxnbAUNEGEwzzOkuGPZDlEIKxQAchPAOIRRZnu-DARKcEk7REPBp1ekm2CQ2lfWq1jYprGu8TVRtEuWi9Ym3taqS2E9DW6k6qlg29SHYc6oK9mhzjsDLzfXzZJbOH6e3k8t5qiniMUWYFZwxIyjXIoOUQuK0y40pNFTW0UJjBjNtjCbEOYudMMTA3iqIKSkEHoGz9d7WN5-dDVEuy6Bt1T_ENl2Qef9fToUg_0uMEcY4W8nztdS-CcFbJ1tfLpX_lgjKVVLZJ5XrpD0-2aztiqU1W7pp2IPTDVBBq8qtKpbh12UZ45DyfOuarv37wnTtyhDt169U_kOyHOdUzl4X8gHzq_unu4Uk-AdF55s5</recordid><startdate>20100301</startdate><enddate>20100301</enddate><creator>Bergrem, Henrik Andreas</creator><creator>Valderhaug, Tone Gretland</creator><creator>Hartmann, Anders</creator><creator>Bergrem, Harald</creator><creator>Hjelmesæth, Jøran</creator><creator>Jenssen, Trond</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QP</scope></search><sort><creationdate>20100301</creationdate><title>Glucose tolerance before and after renal transplantation</title><author>Bergrem, Henrik Andreas ; Valderhaug, Tone Gretland ; Hartmann, Anders ; Bergrem, Harald ; Hjelmesæth, Jøran ; Jenssen, Trond</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-136b866d958c9205504fcf7ddbc0aef5bc3602cddc44ffe3f9d4d08c9a0354b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Continental Population Groups</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Diabetes Mellitus - ethnology</topic><topic>Diabetes Mellitus - physiopathology</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Glucose Intolerance - ethnology</topic><topic>Glucose Intolerance - physiopathology</topic><topic>Glucose Tolerance Test</topic><topic>Humans</topic><topic>hyperglycaemia</topic><topic>Hyperglycemia - epidemiology</topic><topic>Hyperglycemia - ethnology</topic><topic>Hyperglycemia - physiopathology</topic><topic>Intensive care medicine</topic><topic>Kidney Transplantation - ethnology</topic><topic>Kidney Transplantation - physiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>multiple imputation</topic><topic>oral glucose tolerance test</topic><topic>Predictive Value of Tests</topic><topic>Renal Insufficiency - ethnology</topic><topic>Renal Insufficiency - physiopathology</topic><topic>Renal Insufficiency - surgery</topic><topic>renal transplantation</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>urea</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bergrem, Henrik Andreas</creatorcontrib><creatorcontrib>Valderhaug, Tone Gretland</creatorcontrib><creatorcontrib>Hartmann, Anders</creatorcontrib><creatorcontrib>Bergrem, Harald</creatorcontrib><creatorcontrib>Hjelmesæth, Jøran</creatorcontrib><creatorcontrib>Jenssen, Trond</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Calcium & Calcified Tissue Abstracts</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bergrem, Henrik Andreas</au><au>Valderhaug, Tone Gretland</au><au>Hartmann, Anders</au><au>Bergrem, Harald</au><au>Hjelmesæth, Jøran</au><au>Jenssen, Trond</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glucose tolerance before and after renal transplantation</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><stitle>Nephrol Dial Transplant</stitle><addtitle>Nephrol Dial Transplant</addtitle><date>2010-03-01</date><risdate>2010</risdate><volume>25</volume><issue>3</issue><spage>985</spage><epage>992</epage><pages>985-992</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><coden>NDTREA</coden><abstract>Background. Renal insufficiency predisposes to insulin resistance, hyperparathyroidism and derangements in calcium phosphate and nitrogenous compound balance, leading to pre-transplant hyperglycaemia. These metabolic risk factors are not fully corrected after renal transplantation. The present study aimed to assess the role of pre-transplant glycaemia and the named metabolic risk factors in post-transplant hyperglycaemia [PHYG; impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or diabetes mellitus (DM)]. Methods. This is a retrospective cohort study involving 301 patients without pre-transplant DM. Measurements included a pre- and post-transplant oral glucose tolerance test (OGTT) as well as glomerular filtration rate (GFR), parathyroid hormone (PTH), phosphate, calcium and urea measured 10 weeks post-transplant. The risk of PHYG at 10 weeks post-transplant was analysed using multiple logistic regression. Results. Ninety-three patients (31%) had PHYG (two IFG, 52 IGT, 39 DM). Variables associated with PHYG included pre-transplant 2-h glycaemia [OR 1.26, 95% CI (1.09, 1.46)] and post-transplant urea levels [OR 1.14, 95% CI (1.02, 1.27)]. Older age, non-Caucasian ethnicity, previous transplants, ≥3 HLA class 1 mismatches and high prednisolone doses were likewise associated with an increased PHYG risk (all P < 0.05). Conclusions. Pre-transplant glycaemia and high post-transplant levels of urea were associated with a greater risk of PHYG. This seemed to be independent of GFR, PTH, phosphate, calcium and traditional risk factors such as age and glucocorticoid load.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>19854851</pmid><doi>10.1093/ndt/gfp566</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Factors Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cohort Studies Continental Population Groups Diabetes Mellitus - epidemiology Diabetes Mellitus - ethnology Diabetes Mellitus - physiopathology Emergency and intensive care: renal failure. Dialysis management Female Glomerular Filtration Rate Glucose Intolerance - ethnology Glucose Intolerance - physiopathology Glucose Tolerance Test Humans hyperglycaemia Hyperglycemia - epidemiology Hyperglycemia - ethnology Hyperglycemia - physiopathology Intensive care medicine Kidney Transplantation - ethnology Kidney Transplantation - physiology Male Medical sciences Middle Aged multiple imputation oral glucose tolerance test Predictive Value of Tests Renal Insufficiency - ethnology Renal Insufficiency - physiopathology Renal Insufficiency - surgery renal transplantation Retrospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system urea |
| title | Glucose tolerance before and after renal transplantation |
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