Atherosclerosis in Patients Undergoing Kidney Transplantation: Insulin Resistance and Its Relationship with Serum Fetuin-A

Aim: Cardiovascular disease (CVD) is the most important cause
of mortality in patients undergoing kidney transplantation. In
addition to classical CVD risk factors, insulin resistance and fetuin-A,
a vascular calcification inhibitor, may also affect the pathogenesis
of atherosclerosis in this group of patients. In our study, we
investigated the risk factors for atherosclerosis in patients who
underwent kidney transplantation and the relationship between
atherosclerosis and insulin resistance and fetuin-A.
Material and Method: The study included 103 kidney
transplant patients (69 males, mean age 35.14±9.51 years; mean
kidney transplant time 54.99±39.51 months) and 70 healthy
controls. Patients over 18 years of age, with a kidney transplant
period of at least 6 months, and without diabetes mellitus,
acute or chronic infection, acute hepatitis, or malignancy were
included in the study. Demographic, clinical and laboratory
data of the control group and patient group were recorded. All
participants in the study had carotid-intima media thickness
(C-IMT) measured by the same radiologist.
Results: Body mass index, systolic and diastolic blood pressures,
mean arterial blood pressure values, serum creatinine, cholesterol,
triglyceride, high-density lipoprotein, parathyroid hormone,
calcium and C-reactive protein (CRP) levels, HOMA insulin
resistance values and C-IMT values were higher in the recipients
compared to the control group, and creatinine clearance and
serum fetuin-A levels were lower. When the patients were
examined in three groups according to serum fetuin-A level;
In the group with the lowest fetuin-A levels, age (p=0.005),
hepatitis B or C disease rate (p=0.005), serum CRP (p=0.001)
and C-IMT (p<0.001) were higher, and albumin value (p=0.02)
was found to be lower. Multivariant linear regression analysis
found age (ß=0.436; p<0.001) and fetuin-A (ß=−0.229; p=0.04) as
independent risk factors associated with C-IMT.for what ??
Conclusion: Apart from the classical CVD risk factors, insulin
resistance and low serum fetuin-A levels were also found to
be associated with the development of early atherosclerosis
in kidney transplant patients. Prospective long-term studies
showing the course of serum fetuin-A levels in kidney
transplant patients are needed.