Endocrine Abstracts

Aims: Diabetic nephropathy (DN) is a leading cause of chronic kidney disease (DKD). Various hormonal disturbances are not rare among DKD patients. Adipose tissue as an active endocrine organ with multiple metabolic effects may play an extra important role in hormonal disbalance during progressive kidney function decline. The purpose of the study was to investigate potential relationship between thyroid status and adiponectin levels in patients with type 1 diabetes (T1D) and DKD after renal transplantation (RT).

Materials and methods: We recruited 121 patients (43 m; 78 f; age 42.26±11.670 yrs; duration of T1D 23.07±9.95 yrs) with T1D. Hypertension was observed in 84(69.42%) patients, 62(51.24%) patients took ACE inhibitors. Dyslipidemia was found in 107(88.43%) patients, and only 34(28.10%) of them received statins. GFR was estimated by CKD-MDRD formula. Kidney injury was assessed using NGAL. All patients were divided into 2 groups: the group 1 comprised 105 patients at stages 2–4 of DKD (GFR 64.0[49.00; 75.00] ml/min); group 2–16 patients with DKD after renal transplantation (GFR 42.5[27.95; 51.15] ml/min). In group 1–21 patients received replacement therapy with levothyroxin, in group 2 only 1 (mean dosage 106.55±37.84 mcg vs 25.00 mcg). Biochemical parameters, HbA1c, thyroid hormones, NGAL, adiponectin levels were measured. Nonparametric statistical methods were used. A P-value <0.05 was considered significant.

Results: Groups were matched by age, gender, HbA1c, diabetes duration, blood pressure, LDLc levels. Comparative analysis of patients in the subgroups revealed reliable differences in BMI (P=0.028), adiponectin (P=0.034), NGAL (P=0.009), TSH (P=0.048), AbTSH-R (P=0.002). Mean BMI in group 1(25.53[22.54; 28.74]) was higher than those after RT(23.17 [20.87; 24.71]). Adiponectin levels were higher in patients after RT(26.65[16.73; 69.31]) vs DKD(14.18[10.46; 23.60]). Mean TSH levels were higher in patients after RT(3.16[2.39; 4.41] vs 2.27[1.61; 3.55]). AbTSH-R were much lower in patients after RT(0.33±0.08 vs 0.545[0.3; 1.21]). NGAL levels were significantly higher in patients after RT 3.49[3.27; 6.69] vs 0.88[0.48; 1.75]. Correlation of adiponectin and TSH was observed in group 2(r=0.812). In patients after RT TSH levels correlate with BMI (r=0.579). In group 1 inverse correlations of adiponectin and BMI was revealed (r=−0.273).

Conclusion: Patients with T1D after RT have reliably higher levels of TSH and adiponectin than patients with stages 2–4 of DKD, which may represent deeper metabolic disorders than in patients before transplantation.