New-onset Diabetes and Left Ventricular Hypertrophy in Renal Transplantation
Condition: Diabetes Mellitus Nos New Onset; Hypertrophy, Left Ventricular; Vascular Stiffness
MeSH terms: Hypertrophy, Left Ventricular; Diabetes Mellitus; Hypertrophy
Study type: Observational

Summary: 
      New-onset diabetes (NODAT) after solid organ transplantation is an important clinical
      challenge associated to increased risk of cardiovascular (CV) events. In end-stage renal
      disease (ESRD) patients, the impact of arterial stiffness on all-cause and CV mortality has
      been clearly documented. Arterial stiffness has a pivotal role in the genesis of high blood
      pressure (SBP), increased left ventricular hypertrophy (LVH), and consequently CV mortality.
      Both LVH and arterial stiffness are independent determinants of CV disease in patients with
      ESRD. The aim of this study is to evaluate the relationship between post-transplant new-onset
      diabetes and arterial stiffness and left ventricular mass index (LVMI) in kidney transplant
      recipients.
    

Detailed description: 
      All patients' data were recorded from clinical charts. Visits in out patient clinic were
      organized as follows: three visits per week during the first 2 weeks; two visits per week
      until day 60; weekly visits until day 120; monthly visits during the first year; one visit
      every other month during the second year; and four visits per year thereafter until death or
      end-stage renal disease (i.e. dialysis or retransplantation). The following parameters were
      collected; 1) age, 2) gender, 3) posttransplantation duration, 4) pretransplant hemodialysis
      duration, 4) acute rejection episodes, 5) use of statins, ace inhibitor (ACE) or angiotensin
      receptor blocker (ARB), 6) immunosuppressive treatment (mycophenolate, cyclosporine,
      tacrolimus, and sirolimus use), 7) pretransplant lipid profile (values in the last month
      before transplantation), 8) posttransplant lipid profile (mean value), 9) FPG and HbA1c
      levels (mean value), 10) office blood pressure measurements, 11) hemoglobin, calcium,
      phosphorus, albumine and parathyroid hormone levels, 12) creatinine and estimated GFR (MDRD
      equation) and, 13) cytomegalovirus (CMV) infection history. Mean values were arithmetic means
      of each parameter that were collected from patient charts at 3 monthly basis after the first
      posttransplant 6 months while other parameters (12-16) were collected as single values at
      study inclusion.

      All patients were under 5 mg prednisolone treatment within the immuno suppressive regimen.
      Maintenance immunosuppressive treatment included prednisone with a gradual tapering and
      mycophenolate mofetil or sodium associated with cyclosporine, tacrolimus or sirolimus in most
      patients. Target through levels at 3 months were 150-250 ng/ml for cyclosporine and 8-12
      ng/ml for tacrolimus and sirolimus. Anti-diabetic treatment modalities (diet and lifestyle
      changes, oral anti-diabetic drugs or insulin) were also recorded for patients with NODAT.

      Body compositions of all patients were analyzed by using the Body Composition Analyzer
      (Tanita BC-420MA). Fat mass, fat free mass, muscle mass, visceral fat mass and body mass
      index were calculated for each patient.

      All patients underwent echocardiographic examinations (Siemens Acuson C256, Mountain view,
      California 2000 with 3V2c transducer probe) by the same operator and left ventricular mass
      was calculated according to the Devereux formula and indexed to body surface area to give
      LVMI (g/m2). Left ventricular mass index values greater than 130g/m2 (n: 57) were defined as
      high left ventricular mass.

      Pulse wave velocity (PWv) is defined as the velocity of the arterial pulse for moving along
      the vessel wall. Pulse wave velocity along the aorta was measured by using two ultrasound or
      pressure sensitive transducers fixed transcutaneously over the course of a pair of arteries
      separated by a known distance: the femoral and right common carotid arteries. PWV was
      calculated from measurements of pulse transit time and the distance, according to the
      following formula: PWV (m/s)= distance (m)/transit time (s). Measurement of PWV values was
      con-ducted after abstinence from caffeine or smoking and after an overnight fast without
      intake of antihypertensive drugs. PWV was determined by using the SphygmoCor CvMs V9 system
      and values > 7 m/s was defined as increased.
    

Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Between years 2007-2010, 63 patients were diagnosed as NODAT in our transplantation center
        from the total 267 patients who underwent renal transplantation. Among these, 159 kidney
        transplant recipients were selected.
      
Keywords: Glucose Regulation; Left Ventricular Hypertrophy; New-onset Diabetes; Renal Transplantation