TY - JOUR
T1 - Insulin Sensitivity After Living Donor Nephrectomy
AU - Tanriover, Bekir
AU - Lingvay, Ildiko
AU - Ahmed, Firas
AU - Sandikci, Burhaneddin
AU - Mohan, Sumit
AU - Cremers, Serge
AU - Karmally, Wahida
AU - Mohan, Prince
AU - Newhouse, Jeffrey
AU - Ragunathan, Sneha
AU - AbdulRahim, Nashila
AU - Ariyamuthu, Venkatesh Kumar
AU - Ratner, Lloyd E.
AU - Cohen, David J.
N1 - Funding Information:
This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1RR024156. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Background: The kidney is essential for glucose and insulin metabolism. Living kidney donors (LKDs) experience a reduction in glomerular filtration rate of 25 to 30 mL/min after donor nephrectomy. Little is known about the effect of glomerular filtration rate decline on insulin sensitivity in LKDs. Methods: We conducted a prospective pilot study on 9 LKDs (N = 9) who underwent dynamic metabolic testing (mixed meal tolerance test) to measure proxies of insulin sensitivity (homeostatic model assessment of insulin resistance, the area under curve [AUC] for insulin/glucose ratio, and Matsuda insulin sensitivity index) before and 3 months after donor nephrectomy. The primary outcome was the change in insulin sensitivity indices (delta [post-nephrectomy – pre-nephrectomy]). Results: Four of the donors had a body mass index (BMI) between 32.0 and 36.7 predonation. Post–donor nephrectomy, compared with prenephrectomy values, median insulin AUC increased from 60.7 to 101.7 hr*mU/mL (delta median 33.3, P = .04) without significant change in median glucose AUC levels from 228.9 to 209.3 hr*mg/dL (delta median 3.2, P = .77). There was an increase in the median homeostatic model assessment of insulin resistance from 2 to 2.9 (delta median 0.8, P = .03) and the AUC insulin/glucose ratio from 30.9 to 62.1 pmol/mmol (delta median 17.5, P = .001), whereas the median Matsuda insulin sensitivity index decreased from 5.9 to 2.9 (delta median −2, P = .05). The changes were more pronounced in obese (BMI >32) donors. Conclusion: LKDs appear to have a trend toward a decline in insulin sensitivity post–donor nephrectomy in the short term, especially in obese donors (BMI >32). Further investigation with a larger sample size and longer follow-up is needed.
AB - Background: The kidney is essential for glucose and insulin metabolism. Living kidney donors (LKDs) experience a reduction in glomerular filtration rate of 25 to 30 mL/min after donor nephrectomy. Little is known about the effect of glomerular filtration rate decline on insulin sensitivity in LKDs. Methods: We conducted a prospective pilot study on 9 LKDs (N = 9) who underwent dynamic metabolic testing (mixed meal tolerance test) to measure proxies of insulin sensitivity (homeostatic model assessment of insulin resistance, the area under curve [AUC] for insulin/glucose ratio, and Matsuda insulin sensitivity index) before and 3 months after donor nephrectomy. The primary outcome was the change in insulin sensitivity indices (delta [post-nephrectomy – pre-nephrectomy]). Results: Four of the donors had a body mass index (BMI) between 32.0 and 36.7 predonation. Post–donor nephrectomy, compared with prenephrectomy values, median insulin AUC increased from 60.7 to 101.7 hr*mU/mL (delta median 33.3, P = .04) without significant change in median glucose AUC levels from 228.9 to 209.3 hr*mg/dL (delta median 3.2, P = .77). There was an increase in the median homeostatic model assessment of insulin resistance from 2 to 2.9 (delta median 0.8, P = .03) and the AUC insulin/glucose ratio from 30.9 to 62.1 pmol/mmol (delta median 17.5, P = .001), whereas the median Matsuda insulin sensitivity index decreased from 5.9 to 2.9 (delta median −2, P = .05). The changes were more pronounced in obese (BMI >32) donors. Conclusion: LKDs appear to have a trend toward a decline in insulin sensitivity post–donor nephrectomy in the short term, especially in obese donors (BMI >32). Further investigation with a larger sample size and longer follow-up is needed.
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U2 - 10.1016/j.transproceed.2021.06.007
DO - 10.1016/j.transproceed.2021.06.007
M3 - Article
C2 - 34246476
AN - SCOPUS:85109430947
VL - 53
SP - 1858
EP - 1864
JO - Transplantation Proceedings
JF - Transplantation Proceedings
SN - 0041-1345
IS - 6
ER -