Medical Department, Section of Nephrology, Vestfold Central Hospital, Tønsberg, 1 Medical Department, Section of Nephrology, National Hospital, Oslo, Norway,
Sir,
Insulin resistance has been reported in patients with adult polycystic kidney disease (APKD) [1], and Ducloux and coworkers recently suggested in a preliminary report that renal transplant recipients with APKD were at increased risk of post-transplant diabetes mellitus (PTDM) [2]. In a retrospective case-control study including 26 APKD recipients (cases) and 26 controls matched for age, gender and immunosuppressive therapy, a significantly higher prevalence of PTDM was observed in the former group than the latter (34.6 vs 15.3%) [2]. However, the authors did not include patients with impaired glucose tolerance (IGT) after renal transplantation, which is important to assess whether recipients with APKD are predisposed to develop post-transplant glucose intolerance.
In a single centre study we examined glucose intolerance prospectively in 173 consecutive renal transplant recipients at 10 weeks after transplant [3]. In the majority (n=167) an oral glucose tolerance test (OGT) was performed. Patients with pretransplant diabetes mellitus were excluded. Thirty-one patients (18%) had PTDM, 53 (31%) IGT and 89 (51%) normal glucose tolerance (NoGT).
The primary renal disease was included in the univariate model, and nephrosclerosis was more prevalent in the PTDM group (7 of 31; 23%) than in the NoGT group (6 of 89; 7%) (P<0.05). However, multiple stepwise logistic regression analysis revealed that actual daily prednisolone dose and age were the only independent predictors of both PTDM and IGT. A positive family history of diabetes mellitus was also independently associated with PTDM but not with IGT.
APKD was the primary renal disease in 29 of 173 recipients (17%) in our study (Figure 1) and was not more common in glucose intolerant recipients (11 of 84; 13%) than in the patients with NoGT (18 of 89; 20%). On the contrary a slightly but significantly lower proportion of recipients in the group with IGT had APKD than in both the NoGT group (P<0.05) and the PTDM group (P<0.05) (
2). The prevalence of APKD was similar in the PTDM group (23%) and the NoGT group (20%). The three groups were not statistically different with respect to prednisolone dose, age and family history of diabetes (Figure 1
). This sub-analysis must however be interpreted with caution because of the small numbers of patients assessed.
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