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

Abstract

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.

New-Onset Diabetes and Glucose Regulation Are Significant Determinants of Left Ventricular Hypertrophy in Renal Transplant Recipients

“…A number of studies revealed that restoration of renal function after renal transplantation could partially improve increased arterial stiffness [ 20 , 21 ]. On the other hand, it has also been shown that renal transplant recipients with glucose intolerance had increased PWv, suggesting that glucose intolerance may induce atherosclerosis [ 4 , 5 , 22 ].…”

Tacrolimus and angiotensin receptor blockers associated with changes in serum adiponectin level in new-onset diabetes after renal transplantation: single-center cross-sectional analysis

“…Plasma adiponectin levels in humans are significantly lower among subjects who are obese, display coronary artery disease caused by atherosclerosis, and have hypertension [6–8]. In NODAT patients, the degree of atherosclerosis determined by brachial‐ankle pulse wave velocity was shown to increase with a decrease in adiponectin level [9]. In addition, this secretory protein may be involved in the pathogenesis of type 2 diabetes mellitus, based on its relationship with insulin and glucose metabolism [10,11].…”

Low serum adiponectin level is predictor of arterial stiffness in new onset diabetes after renal transplantation

“…Our results showed that a low pre-transplant serum adiponectin level is a predictor of arterial stiffness and NODAT in renal transplant patients, with a significant inverse correlation found between mean pre-transplant serum adiponectin and ba-PWV levels. Previous studies have demonstrated that a low serum adiponectin level is an independent predictor of high baPWV level in essential hypertension [9] and renal transplant [10] patients. Our results support those findings.…”