Cardiovascular risk profile in kidney transplant recipients with well controlled hypertension

Background and Aim: To study the alterations of carbohydrate and lipid metabolism in a group of renal-transplant recipients. Methods and Results: A case-control study was carried out on 44 renal-transplant recipients with normal kidney function and oral glucose tolerance, and a control group of 37 healthy subjects. The following variables were studied: a) anthropometric and clinical, b) diet, c) composition of the adipose tissue fatty acids d) glycemia, insulin, and C peptide at baseline and after oral glucose tolerance rest (OGTT), e) cholesterol, triglycerides, and Apo B in total plasma and in high density lipoprotein (HDL), very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), and low density lipoprotein (LDL) separated by ultracentrifugation, Apo A-I, Apo CII, and Apo CIII in plasma. The renal-transplant recipients had a greater waist to hip ratio (0.89+/-0.09 vs 0.69+/-0.07, p=0.0008) compared to controls. Calorie intake was similar but the transplant recipients had a lower intake of saturated fat per day (31.4+/-9.6 vs 37.4+/-10.98 g/day, p=0.05). The composition of fatty acids in adipose tissue was the same in cases and controls, except for a greater proportion of lauric acid in the transplant recipients (p=0.05). The transplant recipients had significantly higher levels of cholesterol, triglycerides, and Apo B both in plasma and in VLDL, LDL, and IDL. The Apo A-I, Apo CII, and Apo CIII were significantly raised in the transplant recipients, but the Apo CII/Apo CIII ratio was significantly reduced (p=0.005). The HDL levels were similar in the transplant recipients and controls except for the HDL triglycerides, which were significantly higher (p=0.0002). Insulin values in serum were higher in the transplant recipients over the whole glucose curve with statistically significant differences at minute 90 of the curve (p=0.05). C peptide was higher in the transplant recipients at baseline (3.83+/-5.31 ng/ml VS 1.70+/-0.61 ng/ml, p=0.0001) and at minute 180 of the curve (p=0.03). The C peptide/insulin ratio was also significantly raised at these same times. Transplant recipients with hypertension had higher levels of blood glucose at minutes 30 (p=0.04) and 90 (p=0.01) of the curve, as well as a larger area under the glucose curve (p=0.03). They also had significantly higher levels of insulin at minute 90 (p=0.03), total Apo B (p=0.05), Apo B in LDL (p=0.03) and LDL-cholesterol (p=0.05). Conclusions: The rise in cholesterol and plasma triglycerides, rite apolipoprotein distribution pattern, the redistribution of the body fat, the changes in carbohydrate and insulin metabolism, are all the expression in renal-transplant recipients of a plurimetabolic syndrome, probably secondary to the simultaneous action of steroids, cyclosporine and hypotensive agents. (C) 1998, Medikal Press.