Obesity, Adiponectin and Inflammation as Predictors of New-Onset Diabetes Mellitus After Kidney Transplantation

Bayés, Beatriz; Granada, María Luisa; Pastor, María Antonia; Lauzurica, Ricardo; Salinas, Isabel; Sanmartı́, Anna; Espinal, Anna; Serra, Assumpta; Navarro, Margarita Suárez; Bonal, Jordi; Romero, R.

doi:10.1111/j.1600-6143.2006.01646.x

Cited by 75 publications

(54 citation statements)

References 32 publications

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“…Previous studies have shown that higher ADPN levels are protective against hypertension and new-onset diabetes after transplantation (18,19). We cannot comment on incident diabetes or the BP evolution in our study population; however, our study did not find any suggestion of improved overall patient outcome in those in the highest ADPN range.…”

Section: Discussioncontrasting

confidence: 67%

Serum Adiponectin Levels and Mortality after Kidney Transplantation

Alam

Molnar

Czira

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Adiponectin (ADPN), an adipose tissue-derived hormone, has protective properties with respect to atherogenesis, inflammation, and energy homeostasis. Its beneficial role has not been consistent in patients with CKD or those undergoing dialysis.Design, setting, participants, & measurements This study examined the association of plasma ADPN levels in 987 prevalent kidney transplant recipients (mean age 6 SD, 51.0612.8 years; estimated GFR, 52.8621.9 ml/min per 1.73 m 2 ; median time since transplant, 78 months) on all-cause mortality and death-censored graft failure. Patients were enrolled between February and August 2007 and were followed for a median of 51 months (interquartile range, 49-53 months). Using Cox proportional hazard models, the association of log-transformed plasma adiponectin was studied, with and without adjustment for demographic variables, baseline GFR, markers of inflammation, and cardiovascular risk factors.Results At baseline, patients in the lowest ADPN tertile were significantly more likely to be male; to be smokers; to have a higher baseline GFR, lower systolic BP, and lower HDL cholesterol level; and to have higher body mass index, abdominal circumference, C-reactive protein level, and total cholesterol level. The adjusted hazard ratio for death with elevated plasma ADPN (per natural log) was 1.44, and there was no significant interaction with any relevant cardiovascular risk subgroups (i.e., advanced age; diabetes; or elevated body mass index, waist circumference, C-reactive protein, or Framingham risk score). The hazard for death-censored graft failure was nonsignificant at 1.03.Conclusion Elevated ADPN levels are associated with higher risk for death but not allograft failure in prevalent kidney transplant recipients.

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Section: Discussioncontrasting

confidence: 67%

Serum Adiponectin Levels and Mortality after Kidney Transplantation

Alam

Molnar

Czira

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…HCV infection is a well known risk factor for not only NODAT, but also type 2 diabetes, probably due to impaired insulin action in the liver [35]. In addition to these risk factors, lower adiponectin and higher high sensitive Creactive protein (hs-CRP) levels were recently reported to be associated with NODAT [36], but we failed to observe such correlations.…”

Section: Discussioncontrasting

confidence: 54%

The Impact of New-onset Diabetes on Arterial Stiffness after Renal Transplantation

et al. 2008

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Abstract. New-onset diabetes after renal transplantation (NODAT) is known to be a potent risk factor for cardiovascular events. We therefore investigated the incidence and risk factors for NODAT, and evaluated surrogate endpoints of atherosclerosis in Japanese patients with stable renal function after renal transplantation. Seventy-nine patients were enrolled in the study, and a 75 g oral glucose tolerance test (OGTT) was performed in subjects excluding patients with known NODAT. We evaluated the risk factors for NODAT and the degree of atherosclerosis, determined by brachialankle pulse wave velocity (baPWV), ankle-brachial blood pressure index (ABPI) and intima-media thickness (IMT) of the carotid artery. Eleven patients diagnosed as NODAT had significantly higher fasting plasma glucose before transplantation, blood pressure, and incidence of hepatitis C virus (HCV) infection than patients without NODAT. Multivariate regression analysis revealed that the independent determinant of NODAT was fasting plasma glucose pretransplantation, HCV infection and systolic blood pressure. The baPWV in patients with NODAT was significantly higher compared to that in patients without NODAT. In addition, the independent determinant of baPWV evaluated by multivariate regression analysis was an increase in systolic blood pressure and age, and a decrease of adiponectin levels.In conclusion, we found that high fasting plasma glucose prior to transplantation, HCV infection and high blood pressure are risk factors for NODAT in Japanese patients after renal transplantation. Since NODAT patients have advanced arterial stiffness probably due to high blood pressure, strict control of blood pressure will be important for preventing the development of cardiovascular disease in NODAT.

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“…Recently, a possible relationship between low adiponectin levels and pancreatic ␤ cell dysfunction was suggested (3,4). A negative correlation between body mass index (BMI) and adiponectin levels has been established both in the general population and in patients with renal disease (5)(6)(7)(8).…”

mentioning

confidence: 99%

“…Recently, low pretransplantation adiponectin levels were shown to be associated with increased risk for posttransplantation diabetes mellitus (PTDM) (7).…”

mentioning

confidence: 99%

Hypoadiponectinemia Is Associated with Insulin Resistance and Glucose Intolerance after Renal Transplantation

Hjelmesæth

Flyvbjerg²,

Jenssen³

et al. 2006

Clinical Journal of the American Society of Nephrology

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The objectives of this analysis were (1) to assess whether low serum adiponectin concentrations are associated with insulin resistance, metabolic syndrome, and new-onset posttransplantation diabetes mellitus (PTDM) and (2) to examine the possible effects of immunosuppressive and antihypertensive therapies on circulating adiponectin levels after renal transplantation. A total of 172 consecutive previously nondiabetic renal transplant recipients were examined 3 mo after transplantation, the majority (n ‫؍‬ 167) with an oral glucose tolerance test. Serum adiponectin was measured by an in-house time-resolved immunofluorometric assay. Insulin secretion and insulin sensitivity were estimated by previously validated oral glucose tolerance test-derived indexes. One-and 6-yr follow-up data were available in subgroups of patients. Lower adiponectin levels were significantly associated with insulin resistance but not with insulinopenia. Patients with low adiponectin levels (first quartile) had significantly higher odds of PTDM (odds ratio [OR] 3.6; 95% confidence interval [CI] 1.1 to 12.7; P ‫؍‬ 0.049) and metabolic syndrome (OR 3.9; 95% CI 1.6 to 9.5; P ‫؍‬ 0.003) than patients in the upper (fourth) quartile. The increased risk for PTDM in patients with low adiponectin levels remained significant after adjustment for age, steroid dose, and family history of diabetes. Treatment with ␤ blockers was independently associated with lower serum adiponectin levels, and total steroid dose was associated with higher serum adiponectin levels. Low baseline adiponectin levels were also associated with significantly higher odds of PTDM at 6 yr (OR 6.9; 95% CI ‫؍‬ 1.1 to 41.8; P ‫؍‬ 0.037). Serum adiponectin levels correlate with posttransplantation insulin sensitivity and glucose tolerance. Glucocorticoids and ␤ blockers seem to have opposite effects on circulating adiponectin levels.

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Obesity, Adiponectin and Inflammation as Predictors of New-Onset Diabetes Mellitus After Kidney Transplantation

Cited by 75 publications

References 32 publications

Serum Adiponectin Levels and Mortality after Kidney Transplantation

Serum Adiponectin Levels and Mortality after Kidney Transplantation

The Impact of New-onset Diabetes on Arterial Stiffness after Renal Transplantation

Hypoadiponectinemia Is Associated with Insulin Resistance and Glucose Intolerance after Renal Transplantation

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