This study evaluated insulin resistance(IR) and insulin secretion (IS) changes and the impact of delayed graft function on them in uremic patients in early transplantation. A total of 55 kidney transplant patients; without history of diabetes mellitus, were selected. The basal values of glucose (G) and insulin (I) were used to calculate indexes of IR and beta-cell function; IS, according to the homeostasis equations, before transplantation, in 3rd day after transplantation and at the end of first, second and third week after transplantation. Insulin resistance index more than 2.24 and insulin secretion index more than 100% were considered abnormal. Before transplantation IR was present in 62.5% of patients, while only 20% had impaired IS (p-value = 0.012). At the end of third week with normalization of kidney function in all patients; IR and IS was present in only 22.2 and 11.8 percent of patients respectively (p-value = 0.358). When comparing the IR and IS prevalence before transplantation and 3 weeks after engraftment, IR was significantly reduced (p-value < 0.001), while IS prevalence reduction was not significant (p- value=0.17). Comparing the results , between normal functioning grafts and delayed functioning grafts showed a significant difference in both IR and IS in these two groups ( p-value = 0.018 and 0.024 respectively for IR and IS ). Using regression models, only cumulative cyclosporine dose administered and plasma creatinine changes, were significantly associated with IR (P-value = 0.04 and 0.07 respectively). In conclusion, in uremic non-diabetic hemodialyzed patients IR is significantly more prevalent than impaired IS. Successful transplantation results in significant normalization of IR with no significant effect on IS in early after transplantation. In DGF group there is a significantly more prevalent IR and IS, with resumption of normal graft function, difference between them and normal functioning graft patients disappears at the end of 3rd week after transplantation.
Volume : 6
Issue : 4
Pages : 89
Department of Nephrology, Mashad University Of Medical Sciences,Mashad, Iran.