Comparison of glucose tolerance in renal transplant recipients and hemodialysis patients

Abstract

Background: Impaired glucose tolerance is a risk factor for atherosclerosis in hemodialysis patients and renal transplant recipients.

Methods: To check the relationship of impaired glucose tolerance with the other atherosclerotic risk factors, fasting blood sugar and the standard two hour glucose tolerance test, serum tryglyceride, serum cholesterol, cyclosporine through level (in renal transplant recipients) and hemoglobin A1C were measured in 55 stable renal transplant recipients, 55 hemodialysis patients and 55 healthy controls with similar demographic characteristics. Patients with diabetes mellitus and propranolol consumers were excluded. The mean age and female to male ratio were 39 +/- 7 years and 23/22, respectively.

Results: Four of the renal transplant recipients and twelve of the hemodialysis patients had impaired glucose tolerance. Significant linear correlation was observed with body mass index and IGT only in hemodialysis patients (r = 0.4, p = 0.05). Glucose tolerance also had a significant correlation with triglyceride levels (217.2 +/- 55 mg/dl in hemodialysis patients vs. 214.3 +/- 13 mg/dl in renal transplant recipients and 100.2 +/- 18 mg/dl in control groups, p = 0.001). The glucose tolerance had significant relationship with higher serum cholesterol levels only in the renal transplant recipients (269.7 +/- 54 in renal transplant recipients vs. 199.2 +/- 36.6 mg/dl in hemodialysis and 190.5 +/- 34 mg/dl in control groups, p = 0.0001). In the renal transplant recipients, a linear correlation was observed with glucose tolerance and both the serum cyclosporine level (r = 0.9, p = 0.001) and the hemoglobin A1C concentration (6.2 +/- 0.9 g/dl). The later correlation was also observed in the hemodialysis patients (6.4 +/- 0.7 g/dl; r = 67, p = 0.001).

Conclusions: We conclude that although fasting blood sugar is normal in non-diabetic renal transplant and hemodialysis patients, impaired glucose tolerance could be associated with the other atherosclerotic risk factors.

Figure 1

GTT has a linear relationship with BMI in hemodialysis patients. Impairment of GTT is more significant in the hemodialysis patients with higher BMI. Gtt2 = glucose tolerance test at the second hours of 75 gr oral glucose. bmih = body mass index in hemodialysis patients

Figure 2

The glucose tolerance in the HD patients had a significant linear correlation with the level of serum triglycerides. gttd1= glucose tolerance test in dialysis patients, tgh= serum concentration of triglyceride in hemodialysis patients.

Figure 3

Cyclosporine level and HbA1c have correlations with the IGTT in RT recipients ▲ = Serum Cyclosporine level ○ = HbA1c concentration