Hypothalamic-pituitary-gonadal axis disturbance and its association with insulin resistance in kidney transplant recipients / Distúrbio do eixo hipotálamo-hipófise-gonadal e sua associação com resistência à insulina em receptores de transplante renal

Abstract Objective: To evaluate hypothalamic-pi- tuitary-gonadal (HPG) axis alterations at 1 and 12 months after kidney transplan- tation (KT) and their association with in- sulin resistance. Methods: A retrospective clinical study was conducted in a tertiary care center in kidney transplantation recipients (KTRs) aged 18- 50 years with primary kidney disease and stable renal graft function. LH, FSH, E2/T, and HOMA-IR were assessed at 1 and 12 months after KT. Results: Twenty-five KTRs were included; 53% were men, and the mean age was 30.6±7.7 years. BMI was 22.3 (20.4-24.6) kg/m2, and 36% had hypogonadism at 1 month vs 8% at 12 months (p=0.001). Re- mission of hypogonadism was observed in all men, while in women, hypogonadotropic hypogonadism persisted in two KTRs at 12 months. A positive correlation between go- nadotrophins and age at 1 and 12 months was evident. Fifty-six percent of patients had insulin resistance (IR) at 1 month and 36% at 12 months (p=0.256). HOMA-IR showed a negative correlation with E2 (r=- 0.60; p=0.050) and T (r=-0.709; p=0.049) at 1 month, with no correlation at 12 months. HOMA-IR at 12 months after KT correlated positively with BMI (r=0.52; p=0.011) and tacrolimus dose (r=0.53; p=0.016). Conclusion: Successful KT restores the HPG axis in the first year. Hypogonadism had a negative correlation with IR in the early pe- riod after KT, but it was not significant at 12 months.

Resumo Objetivo: Avaliar as alterações do eixo hipotálamo-hipófise-gonadal (HHG) em 1 e 12 meses após transplante renal (TR) e sua associação com a resistência à insulina. Métodos: Foi realizado um estudo clínico retrospectivo em um centro de cuidados terciários em receptores de transplante renal (RTR) com idade entre 18-50 anos com doença renal primária e função do enxerto renal estável. LH, FSH, E2/T e HOMA-IR foram avaliados em 1 e 12 meses após o TR. Resultados: foram incluídos 25 RTR; 53% eram homens e a média de idade foi de 30,6±7,7 anos. O IMC foi de 22,3 (20,4-24,6) kg/m2 e 36% apresentaram hipogonadismo em 1 mês vs 8% aos 12 meses (p=0,001). A remissão do hipogonadismo foi observada em todos os homens, enquanto nas mulheres, o hipogonadismo hipogonadotrófico persistiu em dois RTR aos 12 meses. Ficou evidente uma correlação positiva entre gonadotrofinas e idade em 1 e 12 meses. Cinquenta e seis por cento dos pacientes apresentaram resistência à insulina (RI) em 1 mês e 36% aos 12 meses (p=0,256). O HOMA-IR mostrou uma correlação negativa com E2 (r=-0,60; p=0,050) e T (r=-0,709; p=0,049) em 1 mês, sem correlação em 12 meses. O HOMA-IR aos 12 meses após TR correlacionou-se positivamente com o IMC (r=0,52; p=0,011) e a dose de tacrolimus (r=0,53; p=0,016). Conclusão: O TR bem-sucedido restaura o eixo HHG no primeiro ano. O hipogonadismo apresentou uma correlação negativa com a RI no período inicial após o TR, mas essa correlação não foi significativa aos 12 meses.

Hypothalamic-pituitary-gonadal axis disturbance and its association with insulin resistance in kidney transplant recipients.

OBJECTIVE: To evaluate hypothalamic-pi- tuitary-gonadal (HPG) axis alterations at 1 and 12 months after kidney transplan- tation (KT) and their association with in- sulin resistance. METHODS: A retrospective clinical study was conducted in a tertiary care center in kidney transplantation recipients (KTRs) aged 18- 50 years with primary kidney disease and stable renal graft function. LH, FSH, E2/T, and HOMA-IR were assessed at 1 and 12 months after KT. RESULTS: Twenty-five KTRs were included; 53% were men, and the mean age was 30.6±7.7 years. BMI was 22.3 (20.4-24.6) kg/m2, and 36% had hypogonadism at 1 month vs 8% at 12 months (p=0.001). Re- mission of hypogonadism was observed in all men, while in women, hypogonadotropic hypogonadism persisted in two KTRs at 12 months. A positive correlation between go- nadotrophins and age at 1 and 12 months was evident. Fifty-six percent of patients had insulin resistance (IR) at 1 month and 36% at 12 months (p=0.256). HOMA-IR showed a negative correlation with E2 (r=- 0.60; p=0.050) and T (r=-0.709; p=0.049) at 1 month, with no correlation at 12 months. HOMA-IR at 12 months after KT correlated positively with BMI (r=0.52; p=0.011) and tacrolimus dose (r=0.53; p=0.016). CONCLUSION: Successful KT restores the HPG axis in the first year. Hypogonadism had a negative correlation with IR in the early pe- riod after KT, but it was not significant at 12 months.

Dermatosis más frecuentes en pacientes con trasplante renal.

OBJECTIVE: To determine the most frequent dermatoses in patients with kidney transplant in the dermatology consultation, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, in Mexico City, in the period from March 2016 to March 2020. METHOD: Descriptive, cross-sectional study that included 153 patients with a complete medical history with prior informed consent and authorization from the hospital ethics committee. RESULTS: All patients presented one or more dermatoses. The most frequent were infectious (mycosis, viral) and, in decreasing order, other dermatoses (keratosis pilaris, melasma), tumorous (benign), inflammatory (seborrheic dermatitis, eczema), probably secondary to drugs and autoimmune (alopecia areata). CONCLUSIONS: All kidney transplant patients presented at least one dermatosis, predominantly those of infectious origin. We recommend dermatological evaluation prior to transplantation for timely diagnosis and treatment of dermatoses that could increase the morbi-mortality of patients.

OBJETIVO: Determinar las dermatosis más frecuentes en pacientes con trasplante renal en la consulta de dermatología del Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, en Ciudad de México, en el período de marzo de 2016 a marzo de 2020. MÉTODO: Estudio descriptivo, transversal que incluyó 153 pacientes con historia clínica completa, previo consentimiento informado y autorización del comité de ética del hospital. RESULTADOS: Todos los pacientes presentaron una o más dermatosis. Las más frecuentes fueron las infecciosas (micosis, virales) y, en orden decreciente, otras dermatosis (queratosis pilar, melasma), tumorales (benignas), inflamatorias (dermatitis seborreica, eccemas), probablemente secundarias a fármacos y autoinmunitarias (alopecia areata). CONCLUSIONES: Todos los pacientes receptores de trasplante renal presentaron al menos una dermatosis, predominando las de origen infeccioso. Recomendamos una valoración dermatológica previa al trasplante para el diagnóstico y el tratamiento oportuno de las dermatosis que podrían aumentar la morbimortalidad de los pacientes.

Kidney graft functionality 1 year after kidney transplantation.

OBJECTIVE: To determine the evolution, associated factors and the outcomes of transplanted people one year after the evolution of a cohort in Mexico. METHOD: Kidney transplant cohort from 2013 to 2017 in Mexico. 1118 patients were analyzed. Five outcomes were studied: overall survival, kidney graft, patient survival, delayed function, and acute dysfunction. Kaplan-Meier was used for kidney graft survival. For risk, bivariate and multivariate analyzes were performed with a significant value of p < 0.05. RESULTS: Of the 1118 kidney transplant patients, 57 (5.09%) had kidney graft loss, 52 (4.65%) died during the one-year follow-up; survival of the patient of 95.35% and of the graft 90.25%. CONCLUSIONS: The risk factors for the outcomes were transplantation from a deceased donor, recipient over 50 years of age and use of polyclonal agents. Infections and age are related to the death of the patient.

OBJETIVO: Determinar la funcionalidad del injerto renal a 1 año en una cohorte retrospectiva en México. MÉTODO: Cohorte de trasplante renal de 2013 a 2017 en México. Se analizaron 1118 pacientes. Se estudiaron cinco desenlaces: supervivencia global, supervivencia del injerto renal, supervivencia del paciente, función retardada y disfunción aguda. Para la supervivencia del injerto renal se usó Kaplan-Meier. Para el riesgo se realizó análisis bivariado y multivariado con valor significativo p < 0.05. RESULTADOS: De los 1118 pacientes con trasplante renal, 57 (5.09%) tuvieron pérdida del injerto, 52 (4.65 %) fallecieron durante el año de seguimiento; la supervivencia del paciente fue del 95.35% y la supervivencia del injerto fue del 90.25%. CONCLUSIONES: Los factores de riesgo para los desenlaces fueron trasplante de donante fallecido, receptor mayor de 50 años y uso de agentes policlonales. Las infecciones y la edad están relacionadas con la muerte del paciente.

Biochemical Characteristics of Bone Mineral Metabolism before and throughout the First Year after Kidney Transplantation, Persistent Hyperparathyroidism, and Risk Factors in a Latin Population.

Bone mineral metabolism disease, which included persistent hyperparathyroidism, is common after successful kidney transplantation (KT) and is related with negative outcomes in kidney transplant recipients. There is a lack of information about bone mineral metabolism, persistent hyperparathyroidism, and its risk factors in Latin kidney transplant recipients (KTRs). Material and Methods: A retrospective study was conducted in 74 patients aged 18-50 years with evolution of 12 months after KT and estimated glomerular filtration rate (eGFR) >60 ml/min; biochemical data of bone mineral metabolism before and at 1, 3, 6, and 12 months of KT were registered. Results. Age was 33 (IQR 27-37) years; 54% (n = 40) were men. Before KT, all patients had hyperparathyroidism, 40% (n = 30) hypocalcemia, 86% (n = 64) hyperphosphatemia, and 42% (n = 31) hyperphosphatasemia. After KT, an increase of calcium and a diminution of PTH, phosphorus, and alkaline phosphatase were corroborated (p=0.001). All patients had hypovitaminosis D (deficiency: 91% (n = 67); insufficiency: 9% (n = 7)); 40% (n = 30) had persistent hyperparathyroidism at 12 months. Hyperphosphatasemia before KT (OR = 4.17 (95% CI: 1.21-14.44); p=0.04), hyperparathyroidism at 6 months (OR = 1.84 (95% CI; 1.67-2.06); p=0.02), hypovitaminosis D at 6 months (OR = 3.94 (95% CI: 1.86-17.9); p=0.01), and hyperphosphatasemia at 6 months (OR = 1.47 (95% CI: 1.07-2.86); p=0.03) were risk factors for persistent hyperparathyroidism at 12 months after KT. Conclusion. Persistent hyperparathyroidism at 6 months, hypovitaminosis D, and hyperphosphatasemia are risk factors for persistent hyperparathyroidism at 1 year of KT in Latin population.