Hyperinsulinemia and Hyperfiltration in Renal Transplantation
Por:
Porrini, E, Bayes, B, Diaz, JM, Ibernon, M, Benitez, R, Dominguez, R, Moreno, JM, Delgado, P, Lauzurica, R, Silva, I, Moreso, F, Lampreabe, I, Arias, M, Osuna, A and Torres, A
Publicada:
27 ene 2009
Categoría:
Transplantation
Resumen:
Background. Insulin-resistance hyperinsulinemia is a novel risk factor for renal disease in the general population. Glomerular hyperfiltration has been proposed as an early consequence of hyperinsulinemia.
Methods. In this multicenter cohort study, we analyzed 202 patients without diabetes before or after renal transplantation during the first posttransplant year. Insulin was measured at 3 and 12 months. The majority of patients (91%) were on calcineurin inhibitors. Patients were classified as with persistent normo or hyperinsulinemia when situated below or above the median value of insulin (3 months: 9 mu U/mL; 12 months: 8.74 mu U/mL) at both periods. The 3 to 12 months percent change in calculated creatinine clearance (3-12 months Delta CrCL) was calculated.
Results. Patients with persistent hyperinsulinemia showed a higher increase in 3 to 12 months Delta CrCL compared with those with persistent normoinsulinemia (12% [-20/40] vs. -0.03% [-12/18], P=0.035). We performed a multivariate linear regression analysis with the 3 to 12 months Delta CrCL as the dependent variable and different factors that may induce hyperfiltration, including persistent hyperinsulinemia, as covariates. Persistent hyperinsulinemia was a risk factor for increased CrCL (beta 0.09, 95% CI 0.07/0.12, P=0.035).
Conclusion. In nondiabetic recipients during the first posttransplant year, hyperinsulinemia induced increments in CrCL. As this may herald future renal dysfunction, hyperinsulinemia should not be ignored as a potential target in this population.
Filiaciones:
Porrini, E:
Hosp Univ Canarias, Res Unit, San Cristobal la Laguna, Spain
Bayes, B:
Hosp Germans Trias & Puyol, Nephrol Sect, Badalona, Spain
Diaz, JM:
Fdn Puigvert, Nephrol Sect, Barcelona, Spain
Ibernon, M:
Bellvitge Hosp, Nephrol Sect, Hosp Del Llobregat, Spain
Benitez, R:
Hosp Cruces, Nephrol Sect, Bilbao, Spain
Dominguez, R:
Hosp Marques Valdecilla, Nephrol Sect, Santander, Spain
Moreno, JM:
Hosp Univ Virgen Nieves, Nephrol Sect, Granada, Spain
Delgado, P:
Univ La Laguna, Hosp Univ Canarias, Nephrol Sect, San Cristobal la Laguna 38320, Spain
Hosp Univ Canarias, Res Unit, San Cristobal la Laguna, Spain
:
Hosp Germans Trias & Puyol, Nephrol Sect, Badalona, Spain
Silva, I:
Fdn Puigvert, Nephrol Sect, Barcelona, Spain
Moreso, F:
Bellvitge Hosp, Nephrol Sect, Hosp Del Llobregat, Spain
Lampreabe, I:
Hosp Cruces, Nephrol Sect, Bilbao, Spain
Arias, M:
Hosp Marques Valdecilla, Nephrol Sect, Santander, Spain
Osuna, A:
Hosp Univ Virgen Nieves, Nephrol Sect, Granada, Spain
Torres, A:
Univ La Laguna, Hosp Univ Canarias, Nephrol Sect, San Cristobal la Laguna 38320, Spain
Hosp Univ Canarias, Res Unit, San Cristobal la Laguna, Spain
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