Insulin resistance in patients with adult polycystic kidney disease

Jøran Hjelmesæth and Anders Hartmann1

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 1Go) 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) ({chi}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 1Go). This sub-analysis must however be interpreted with caution because of the small numbers of patients assessed.



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Fig. 1. Frequency of recipients with adult polycystic kidney disease (APKD) (left columns), and independent risk factors of post-transplant diabetes mellitus in APKD-recipients (right columns) related to the three categories of glucose tolerance.

 
In conclusion our data could not support the findings of Ducloux and coworkers with respect to any correlation between APKD and PTDM, and patients with APKD did not have increased risk of post-transplant impaired glucose tolerance. Even though APKD patients are insulin resistant, they do not seem to have increased risk for post-transplant glucose intolerance.

References

  1. Vareesangthip K, Tong P, Wilkinson R, Thomas TH. Insulin resistance in adult polycystic kidney disease. Kidney Int 1997; 52: 503–508[ISI][Medline]
  2. Ducloux D, Motte G, Vautrin P, Bresson-Vautrin C, Rebibou J-M, Chalopin J-M. Polycystic kidney disease as a risk factor for post-transplant diabetes mellitus. Nephrol Dial Transplant 1999; 14: 1244–1246[Abstract]
  3. Hjelmesæth J, Hartmann A, Kofstad J, Stenstrøm J, Leivestad T, Egeland T, Fauchald P. Glucose intolerance after renal transplantation depends upon prednisolone dose and recipient age. Transplantation 1997; 64: 979–983[ISI][Medline]