Vascular calcifications, expressed as arterial intimal calcification (AIC) and arterial
media calcification (AMC), are associated with cardiovascular (CV) morbidity and are
an independent predictor of CV mortality.
We studied 37 nondiabetic renal transplant recipients (RTR) in a stable phase (mean
age 49±12 years, 27M/10F) at least one year posttransplant (80±58 months) and not
treated with oral hypoglycemic agents or insulin. All patients underwent B-Mode ultrasonography
of commune femoral and carotid arteries to determine the presence of calcified plaques.
Superficial femoral and tibial arteries were also investigated for evaluation of media
calcification.
A positive correlation was found between age and glycated haemoglobin while fasting
blood glucose (FBG) was correlated with body max index (BMI). AMC and AIC were present
respectively in 13/37 and 17/37 patients. In AMC, a significant correlation (P<0.0001)
was demonstrate with time of dialysis. In our results a starting point of 30 months
of dialysis for developing calcifications (p<0.01) was also seen.
On basis of femoral AIC, patients with plaques were older (58 vs. 41 years, p<0.001),
they had greater FBG (102mg/dl vs. .87, p<0.001) and glycated haemoglobin (5.7% vs.
5.1%, p<0.001).
According to American Diabetes Association (ADA) criteria, 9/17 pts with femoral AIC
had impaired fasting glucose (IFG) expressed as FBG >100mg/dl, against 1/20 of group
1 (p<0.01). No differences were founded in gender, renal function estimated and immunosuppressive
therapeutic regimens betweens groups.
This study evidences the importance of subclinical diabetes in renal transplants and,
first of all, the relationship between IFG and markers of generalized atherosclerosis;
however an association between older age and alterated glucose metabolism is reported
in general population and maybe it can explain partially plaque formation.
Our results suggest initiation of appropriate intervention also in those patients
with minimal glicemic alterations, frequently underestimated from clinicians and so
not treated.
For last, the presence in our casuistic of AMC in almost forty percent of transplanted
patients, gives importance to an early evaluations in pre-dialysis era for transplantation
list.
