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The impact of kidney transplantation on insulin sensitivity

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OBJECTIVE: To investigate the impact of kidney transplantation (KTx) on insulin sensitivity affecting glucose metabolism.

METHODS: Nine non-diabetic patients awaiting living donor KTx were examined prior to transplantation with an oral glucose tolerance test and a 3h hyperinsulinaemic euglycaemic clamp. The clamp was repeated six months after KTx. Nine age, gender and BMI matched individuals with normal kidney function served as controls. Endogenous glucose production and glucose disappearance rate (N=6) were measured in a subgroup of patients with corresponding controls. Results presented as mean [range].

RESULTS: Two patients had pre-transplant prediabetes whereas all others had normal glucose tolerance. After KTx, average glucose infusion rate to maintain euglycaemia during clamp declined significantly from 15.1 [9.1 - 23.7] to 9.8 [2.8 - 14.6] μmol kg(-1) min(-1) (P<0.01) with 20.2 [9.9 - 33.7] μmol kg(-1) min(-1) in controls. Endogenous glucose production increased from 7.0 [4.8 - 8.5] to 9.4 [7.4 - 11.8] μmol kg(-1) min(-1) (P<0.05) with 7.0 [-3.8 - 10.1] μmol kg(-1) min(-1) in controls. Glucose disappearance rate was unchanged (18.1 [12.9 - 24.5] vs. 17.1 [12.2 - 22.7] μmol kg(-1) min(-1) , NS) with 22.3 [14.6 - 34.3] in controls.

CONCLUSIONS: Insulin sensitivity is reduced six months after KTx and characterised mainly by impaired suppression of the endogenous glucose production. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalTransplant international : official journal of the European Society for Organ Transplantation
Volume30
Issue number3
Pages (from-to)295-304
ISSN0934-0874
DOIs
Publication statusPublished - 2017

ID: 49587659