Hyperglycaemia before and after renal transplantation
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AbstractHyperglycaemia develops in 20-40% of renal transplant recipients, and is associated with increased cardiovascular morbidity and mortality. It is often unclear, however, whether hyperglycaemia is already present before the transplant. To shed light on the natural history of glucose homeostasis in relation to renal transplantation, this thesis in transplantation medicine studied glycaemia before as well as after renal transplantation.
The pretransplant studies aimed to describe the epidemiology of undiagnosed hyperglycaemia in Norwegian renal transplant candidates, and to study the role of pretransplant glycaemia in the development of posttransplant hyperglycaemia. In the posttransplant studies, the aims were to study associations between glycaemia, renal function or related parameters, and prednisolone blood levels. Data included pre- and posttransplant oral glucose tolerance tests, as well as posttransplant measurements of urea, phosphate, calcium, PTH, haemoglobin, GFR, and a 12-hour pharmacokinetic analysis of the exposure to protein bound and unbound prednisolone.
Undiagnosed hyperglycaemia was prevalent in Norwegian transplant candidates. In most patients, the diagnosis required an oral glucose tolerance test. With increasing levels of pretransplant glucose, the risk of posttransplant hyperglycaemia increased in a continuous manner. After transplant, plasma glucose correlated with increasing levels of urea and unbound prednisolone, independent of age, renal function and other factors.
Glucose tolerance should be evaluated in non-diabetic patients awaiting renal transplantation. Posttransplant hyperglycaemia may in part reflect a variable protein metabolism and prednisolone disposition between patients.
List of Papers
1.Bergrem HA, Valderhaug TG, Hartmann A, Hjelmesæth J, Leivestad T, Bergrem H, Jenssen T. Undiagnosed diabetes in kidney transplant candidates: a case finding strategy. Clin J Am Soc Nephrol 2010; 5: 616-622. DOI: 10.2215/CJN.07501009
2. Bergrem HA, Valderhaug TG, Hartmann A, Bergrem H, Hjelmesæth J, Jenssen T. Glucose tolerance before and after renal transplantation. Nephrol Dial Transplant 2010; 25: 985-992 DOI: 10.1093/ndt/gfp566
3. Bergrem HA, Bergrem H, Hartmann A, Hjelmesæth J, Jenssen T. Role of prednisolone pharmacokinetics in postchallenge glycaemia after renal transplantation. Ther Drug Monit 2008; 30: 583-590 DOI: 10.1097/FTD.0b013e318187bb2f