Carotid Atheromatosis in Nondiabetic Renal Transplant Recipients: the Role of Prediabetic Glucose Homeostasis Alterations

Background. Prediabetic glucose homeostasis alterations are important cardiovascular risk factors but their role in renal transplant recipients (RTR) has not been established.Methods. In 172 RTRs without pretransplant or de novo diabetes, we measured carotid intima media thickness (c-IMT) and performed an oral glucose tolerance test (OGTT).Results. In multivariate analysis, age, hypertension and male sex were independently associated with a c-IMT in the third tertile. A significant interaction between gender and glucose homeostasis parameters was observed. Among male RTR, those with a c-IMT in the third tertile showed significantly higher plasma glucose and HbAlc levels (5 +/- 0.5% vs. 5.1 +/- 0.5% vs. 5.5 +/- 0.4%; P < 0.01 tertile 3 vs. 2 or 1) than those in other tertiles. Insulin action parameters were not significantly different. The odds ratio of being in the higher c-IMT tertile was 2.9 (95% CI: 1.05-8.1) per each 1% increase of HbAlc. By contrast, glucose and HbAlc levels were not significantly different between c-IMT tertiles in female RTR. However, age-adjusted insulin levels after OGTT were higher (86 +/- 10 vs. 51.7 +/- 9.4; P=0.02) and the insulin sensitivity index lower (0.8 +/- 0.3 vs. 0.048 +/- 0.03; P=0.04) among females in the third tertile as compared to the first one.Conclusion. Prediabetic glucose homeostasis alterations in RTRs are related to carotid atherosclerosis, although there may be gender differences in the underlying alteration.