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Masked alterations of glucose metabolism among patients awaiting kidney transplantation: Metabolic phenotyping and screening strategies.

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Title: Masked alterations of glucose metabolism among patients awaiting kidney transplantation: Metabolic phenotyping and screening strategies.
Alternate Title: Alteraciones ocultas del metabolismo de la glucosa en pacientes en lista de espera de trasplante renal: Fenotipado metabólico y estrategias de cribado.
Authors: Terán-García, Elena1, Perez-Tamajón, Lourdes1, Rodríguez-López, Celia R.1, Fariña-Hernández, Arminda1, Perez-Carreño, Estefanía2, Marrero-Miranda, Domingo1, Acosta-Sorensen, Cristian1, de Vera-González, Antonia María3, González-Delgado, Alejandra3, Rodríguez-Rodríguez, Ana Elena4, García-Rebollo, Sagrario1, Rodríguez-Adanero, Concepción1, Álvarez-González, Alejandra1, Gonzalez-Rinne, Ana1, Rivero-González, Antonio Manuel5, Macia-Heras, Manuel Luis5, Rodríguez-Hernández, Aurelio P.1, De Bonis-Redondo, Eduardo1, Porrini, Esteban4, Hernández-Marrero, Domingo1,4
Source: Nefrologia. Mar2026, Vol. 46 Issue 3, p1-8. 8p.
Subjects: GLUCOSE tolerance tests, KIDNEY transplantation, INSULIN sensitivity, STATINS (Cardiovascular agents), METABOLIC profile tests, GLUCOSE metabolism, DIABETES
Abstract (English): Background: Patients awaiting kidney transplantation are recommended to undergo systematic oral glucose tolerance tests (OGTT) to detect glucose metabolic alterations (GMA) that heighten the risk of posttransplant diabetes. Aims: (a) To determine GMA prevalence and metabolic phenotypes; (b) assess optimal screening strategies for abnormal OGTT detection; and (c) evaluate one-year GMA trajectory through repeated OGTT during the waiting list period. Methods: OGTTs were conducted on 182 wait-listed patients without diabetes, with 46 undergoing a repeat test after one year. Results: Impaired glucose tolerance (IGT) was most common (23.1%). Undiagnosed diabetes (uDM) and isolated impaired fasting glucose (IFG) were observed in 6% and 4.4%, respectively. Patients with IGT/uDM exhibited decreased insulin secretion, while isolated IFG patients showed reduced insulin sensitivity. Abnormal OGTT correlated with statin therapy [OR 2.4 (1.17-4.9); P = 0.02], fasting glucose [OR 1.03 (1.01-1.06); P = .02], and age [OR 1.03 (1-1.06); P = 0.048]. Patients below age (51 years) and fasting glucose (100 mg/dL) thresholds, not on statins, had lower odds of abnormal OGTT potentially reducing routine testing needs by 26%. Transition from normal to abnormal OGTT after one year correlated with higher baseline BMI [27.5 kg/m² (IQR 25.6-31.7) vs. 24.1 kg/m² (IQR 21.3-25.8); P = 0.04], lower insulin sensitivity [Matsuda index 15.7 (IQR 11.4-24.5) vs. 22.9 (IQR 15.5-37); P = 0.049], and statin use (75% vs. 32%; P = 0.047). Conclusions: One-third of wait-listed patients without manifest diabetes exhibit abnormal OGTT. Age, fasting glucose, and statin use increase risk. Patients below age and fasting glucose thresholds, without statins, have low abnormal OGTT likelihood, potentially reducing routine testing. Annual OGTT may benefit patients initially with normal results, if overweight/obese, or on statins. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Antecedentes: Se recomienda que los pacientes en lista de espera de trasplante renal se sometan sistemáticamente a una sobrecarga oral de glucosa (SOG) para detectar alteraciones del metabolismo de la glucosa (AMG), que aumentan el riesgo de diabetes postrasplante. Objetivos: a) Determinar la prevalencia de las AMG y los fenotipos metabólicos; b) evaluar las estrategias óptimas de cribado para la detección de alteraciones mediante la SOG, y c) analizar la evolución de AMG al año mediante SOG repetidas durante el período en lista de espera. Métodos: Se realizó SOG a 182 pacientes en lista de espera sin diabetes; en 46 de ellos se repitió al año. Resultados: La intolerancia a la glucosa (IGT) fue la alteración más frecuente (23,1%). Se detectó diabetes oculta (DMoc) y glucemia basal alterada (GBA) aislada en el 6% y el 4,4% de los pacientes, respectivamente. Los pacientes con IGT/DMoc mostraron una menor secreción de insulina, mientras que aquellos con GBA aislada presentaron menor sensibilidad a la insulina. Una SOG patológica se asoció con tratamiento con estatinas (OR: 2,4; IC 95%: 1,17-4,9; p = 0,02), glucosa en ayunas (OR: 1,03; IC 95%: 1,01-1,06; p = 0,02) y edad (OR: 1,03; IC 95%: 1-1,06; p = 0,048). Los pacientes de menor edad (51 años), glucosa en ayunas (<100 mg/dl) y sin tratamiento con estatinas presentaron menor probabilidad de SOG patológica, lo que podría reducir pruebas rutinarias en un 26%. La transición de SOG normal a patológica al año se asociócon mayor IMC basal (27,5 kg/m² [RIC: 25,6-31,7] frente a 24,1 kg/m² [RIC: 21,3-25,8]; p = 0,04), menor sensibilidad a la insulina (índice de Matsuda: 15,7 [RIC: 11,4-24,5] vs. 22,9 [RIC: 15,5-37]; p = 0,049) y uso de estatinas (75% vs. 32%; p = 0,047). Conclusiones: Un tercio de los pacientes sin diabetes manifiesta en lista de espera presentan una SOG patológica. La edad, la glucemia en ayunas y el uso de estatinas aumentan el riesgo. Los pacientes más jóvenes, con menor glucemia en ayunas y sin estatinas tienen una baja probabilidad de SOG patológica, lo que podría reducir pruebas de rutina. Una SOG anual podría resultar útil en pacientes inicialmente normales que presenten sobrepeso/obesidad o reciben estatinas. [ABSTRACT FROM AUTHOR]
Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Background: Patients awaiting kidney transplantation are recommended to undergo systematic oral glucose tolerance tests (OGTT) to detect glucose metabolic alterations (GMA) that heighten the risk of posttransplant diabetes. Aims: (a) To determine GMA prevalence and metabolic phenotypes; (b) assess optimal screening strategies for abnormal OGTT detection; and (c) evaluate one-year GMA trajectory through repeated OGTT during the waiting list period. Methods: OGTTs were conducted on 182 wait-listed patients without diabetes, with 46 undergoing a repeat test after one year. Results: Impaired glucose tolerance (IGT) was most common (23.1%). Undiagnosed diabetes (uDM) and isolated impaired fasting glucose (IFG) were observed in 6% and 4.4%, respectively. Patients with IGT/uDM exhibited decreased insulin secretion, while isolated IFG patients showed reduced insulin sensitivity. Abnormal OGTT correlated with statin therapy [OR 2.4 (1.17-4.9); P = 0.02], fasting glucose [OR 1.03 (1.01-1.06); P = .02], and age [OR 1.03 (1-1.06); P = 0.048]. Patients below age (51 years) and fasting glucose (100 mg/dL) thresholds, not on statins, had lower odds of abnormal OGTT potentially reducing routine testing needs by 26%. Transition from normal to abnormal OGTT after one year correlated with higher baseline BMI [27.5 kg/m&#178; (IQR 25.6-31.7) vs. 24.1 kg/m&#178; (IQR 21.3-25.8); P = 0.04], lower insulin sensitivity [Matsuda index 15.7 (IQR 11.4-24.5) vs. 22.9 (IQR 15.5-37); P = 0.049], and statin use (75% vs. 32%; P = 0.047). Conclusions: One-third of wait-listed patients without manifest diabetes exhibit abnormal OGTT. Age, fasting glucose, and statin use increase risk. Patients below age and fasting glucose thresholds, without statins, have low abnormal OGTT likelihood, potentially reducing routine testing. Annual OGTT may benefit patients initially with normal results, if overweight/obese, or on statins. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label: Abstract (Spanish)
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  Data: Antecedentes: Se recomienda que los pacientes en lista de espera de trasplante renal se sometan sistem&#225;ticamente a una sobrecarga oral de glucosa (SOG) para detectar alteraciones del metabolismo de la glucosa (AMG), que aumentan el riesgo de diabetes postrasplante. Objetivos: a) Determinar la prevalencia de las AMG y los fenotipos metab&#243;licos; b) evaluar las estrategias &#243;ptimas de cribado para la detecci&#243;n de alteraciones mediante la SOG, y c) analizar la evoluci&#243;n de AMG al a&#241;o mediante SOG repetidas durante el per&#237;odo en lista de espera. M&#233;todos: Se realiz&#243; SOG a 182 pacientes en lista de espera sin diabetes; en 46 de ellos se repiti&#243; al a&#241;o. Resultados: La intolerancia a la glucosa (IGT) fue la alteraci&#243;n m&#225;s frecuente (23,1%). Se detect&#243; diabetes oculta (DMoc) y glucemia basal alterada (GBA) aislada en el 6% y el 4,4% de los pacientes, respectivamente. Los pacientes con IGT/DMoc mostraron una menor secreci&#243;n de insulina, mientras que aquellos con GBA aislada presentaron menor sensibilidad a la insulina. Una SOG patol&#243;gica se asoci&#243; con tratamiento con estatinas (OR: 2,4; IC 95%: 1,17-4,9; p = 0,02), glucosa en ayunas (OR: 1,03; IC 95%: 1,01-1,06; p = 0,02) y edad (OR: 1,03; IC 95%: 1-1,06; p = 0,048). Los pacientes de menor edad (51 a&#241;os), glucosa en ayunas (&lt;100 mg/dl) y sin tratamiento con estatinas presentaron menor probabilidad de SOG patol&#243;gica, lo que podr&#237;a reducir pruebas rutinarias en un 26%. La transici&#243;n de SOG normal a patol&#243;gica al a&#241;o se asoci&#243;con mayor IMC basal (27,5 kg/m&#178; [RIC: 25,6-31,7] frente a 24,1 kg/m&#178; [RIC: 21,3-25,8]; p = 0,04), menor sensibilidad a la insulina (&#237;ndice de Matsuda: 15,7 [RIC: 11,4-24,5] vs. 22,9 [RIC: 15,5-37]; p = 0,049) y uso de estatinas (75% vs. 32%; p = 0,047). Conclusiones: Un tercio de los pacientes sin diabetes manifiesta en lista de espera presentan una SOG patol&#243;gica. La edad, la glucemia en ayunas y el uso de estatinas aumentan el riesgo. Los pacientes m&#225;s j&#243;venes, con menor glucemia en ayunas y sin estatinas tienen una baja probabilidad de SOG patol&#243;gica, lo que podr&#237;a reducir pruebas de rutina. Una SOG anual podr&#237;a resultar &#250;til en pacientes inicialmente normales que presenten sobrepeso/obesidad o reciben estatinas. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1016/j.nefro.2025.501465
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      – Code: eng
        Text: English
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        PageCount: 8
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      – SubjectFull: GLUCOSE tolerance tests
        Type: general
      – SubjectFull: KIDNEY transplantation
        Type: general
      – SubjectFull: INSULIN sensitivity
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      – SubjectFull: STATINS (Cardiovascular agents)
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      – SubjectFull: METABOLIC profile tests
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      – SubjectFull: GLUCOSE metabolism
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      – SubjectFull: DIABETES
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      – TitleFull: Masked alterations of glucose metabolism among patients awaiting kidney transplantation: Metabolic phenotyping and screening strategies.
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              Text: Mar2026
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