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Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test

BACKGROUND: Simultaneous pancreas-kidney (SPK) transplantation is a proven option of treatment for patients with type 1 diabetes mellitus (T1DM) and related end-stage renal disease. There is discrepancy between the results of different studies about the impact of prolonged normalization of glucose m...

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Autores principales: Argente-Pla, María, Pérez-Lázaro, Antonia, Martinez-Millana, Antonio, Del Olmo-García, María Isabel, Espí-Reig, Jordi, Beneyto-Castello, Isabel, López-Andújar, Rafael, Merino-Torres, Juan Francisco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168717/
https://www.ncbi.nlm.nih.gov/pubmed/32337297
http://dx.doi.org/10.1155/2020/7574628
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author Argente-Pla, María
Pérez-Lázaro, Antonia
Martinez-Millana, Antonio
Del Olmo-García, María Isabel
Espí-Reig, Jordi
Beneyto-Castello, Isabel
López-Andújar, Rafael
Merino-Torres, Juan Francisco
author_facet Argente-Pla, María
Pérez-Lázaro, Antonia
Martinez-Millana, Antonio
Del Olmo-García, María Isabel
Espí-Reig, Jordi
Beneyto-Castello, Isabel
López-Andújar, Rafael
Merino-Torres, Juan Francisco
author_sort Argente-Pla, María
collection PubMed
description BACKGROUND: Simultaneous pancreas-kidney (SPK) transplantation is a proven option of treatment for patients with type 1 diabetes mellitus (T1DM) and related end-stage renal disease. There is discrepancy between the results of different studies about the impact of prolonged normalization of glucose metabolism achieved by SPK on the course of diabetic complications including severe forms of diabetic neuropathy. The objective of the study was to evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) in patients undergoing SPK transplantation and its evolution 10 years after transplantation. METHODS: Prospective study of 81 patients transplanted in a single center from year 2002 to 2015. Autonomic function was assessed using cardiovascular autonomic reflex tests (CARTs). CARTs were made before SPK transplantation and during the follow-up. Evolution of tests after SPK transplantation was evaluated by contrasting hypotheses (paired tests). Multiple testing was adjusted with the Benjamini-Hochberg procedure with a false discovery rate of 10%. RESULTS: 48 males and 33 females, mean age 37.4 ± 5.7 years, mean BMI 24.0 ± 3.4 kg/m(2), and mean duration of diabetes 25.5 ± 6.5 years, received SPK transplantation. Ten years after SPK transplantation, 56 patients re tained the pancreatic graft (42 of them with normofunctioning pancreas and 14 with low doses of insulin therapy). These 42 patients were selected for the autonomic study. Before transplant procedure, all CART results were abnormal. After SPK transplantation, paired test analysis showed an improvement of systolic blood pressure (SBP) response to orthostasis at the 5(th) year after SPK (p = 0.03), as well as improvement of the Valsalva ratio at the 3(rd) (p < 0.001) and 5(th) (p = 0.001) year after SPK. After correcting for the false discovery rate, all the variables of autonomic study reached significance at different time points. CONCLUSIONS: Prevalence of CAN in patients who are candidates for SPK transplantation is high and is generally advanced. SPK transplantation improves CAN with improved Valsalva ratio as the most precocious test.
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spelling pubmed-71687172020-04-24 Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test Argente-Pla, María Pérez-Lázaro, Antonia Martinez-Millana, Antonio Del Olmo-García, María Isabel Espí-Reig, Jordi Beneyto-Castello, Isabel López-Andújar, Rafael Merino-Torres, Juan Francisco J Diabetes Res Clinical Study BACKGROUND: Simultaneous pancreas-kidney (SPK) transplantation is a proven option of treatment for patients with type 1 diabetes mellitus (T1DM) and related end-stage renal disease. There is discrepancy between the results of different studies about the impact of prolonged normalization of glucose metabolism achieved by SPK on the course of diabetic complications including severe forms of diabetic neuropathy. The objective of the study was to evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) in patients undergoing SPK transplantation and its evolution 10 years after transplantation. METHODS: Prospective study of 81 patients transplanted in a single center from year 2002 to 2015. Autonomic function was assessed using cardiovascular autonomic reflex tests (CARTs). CARTs were made before SPK transplantation and during the follow-up. Evolution of tests after SPK transplantation was evaluated by contrasting hypotheses (paired tests). Multiple testing was adjusted with the Benjamini-Hochberg procedure with a false discovery rate of 10%. RESULTS: 48 males and 33 females, mean age 37.4 ± 5.7 years, mean BMI 24.0 ± 3.4 kg/m(2), and mean duration of diabetes 25.5 ± 6.5 years, received SPK transplantation. Ten years after SPK transplantation, 56 patients re tained the pancreatic graft (42 of them with normofunctioning pancreas and 14 with low doses of insulin therapy). These 42 patients were selected for the autonomic study. Before transplant procedure, all CART results were abnormal. After SPK transplantation, paired test analysis showed an improvement of systolic blood pressure (SBP) response to orthostasis at the 5(th) year after SPK (p = 0.03), as well as improvement of the Valsalva ratio at the 3(rd) (p < 0.001) and 5(th) (p = 0.001) year after SPK. After correcting for the false discovery rate, all the variables of autonomic study reached significance at different time points. CONCLUSIONS: Prevalence of CAN in patients who are candidates for SPK transplantation is high and is generally advanced. SPK transplantation improves CAN with improved Valsalva ratio as the most precocious test. Hindawi 2020-04-06 /pmc/articles/PMC7168717/ /pubmed/32337297 http://dx.doi.org/10.1155/2020/7574628 Text en Copyright © 2020 María Argente-Pla et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Argente-Pla, María
Pérez-Lázaro, Antonia
Martinez-Millana, Antonio
Del Olmo-García, María Isabel
Espí-Reig, Jordi
Beneyto-Castello, Isabel
López-Andújar, Rafael
Merino-Torres, Juan Francisco
Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test
title Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test
title_full Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test
title_fullStr Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test
title_full_unstemmed Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test
title_short Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test
title_sort simultaneous pancreas kidney transplantation improves cardiovascular autonomic neuropathy with improved valsalva ratio as the most precocious test
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168717/
https://www.ncbi.nlm.nih.gov/pubmed/32337297
http://dx.doi.org/10.1155/2020/7574628
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