Francisco Moreso

Publications (3)13.23 Total impact

• Article: Hyperinsulinemia and hyperfiltration in renal transplantation.

  Esteban Porrini, Beatriz Bayes, Juan M Diaz, Meritxell Ibernon, Rocio Benitez, Rosa Domínguez, Juan Manuel Moreno, Patricia Delgado, Ricardo Lauzurica, Irene Silva, Francisco Moreso, Ildefonso Lampreabe, Manuel Arias, Antonio Osuna, Armando Torres
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  ABSTRACT: Insulin-resistance hyperinsulinemia is a novel risk factor for renal disease in the general population. Glomerular hyperfiltration has been proposed as an early consequence of hyperinsulinemia. In this multicenter cohort study, we analyzed 202 patients without diabetes before or after renal transplantation during the first posttransplant year. Insulin was measured at 3 and 12 months. The majority of patients (91%) were on calcineurin inhibitors. Patients were classified as with persistent normo or hyperinsulinemia when situated below or above the median value of insulin (3 months: 9 muU/mL; 12 months: 8.74 muU/mL) at both periods. The 3 to 12 months percent change in calculated creatinine clearance (3-12 months DeltaCrCL) was calculated. Patients with persistent hyperinsulinemia showed a higher increase in 3 to 12 months DeltaCrCL compared with those with persistent normoinsulinemia (12% [-20/40] vs. -0.03% [-12/18], P=0.035). We performed a multivariate linear regression analysis with the 3 to 12 months DeltaCrCL as the dependent variable and different factors that may induce hyperfiltration, including persistent hyperinsulinemia, as covariates. Persistent hyperinsulinemia was a risk factor for increased CrCL (beta 0.09, 95% CI 0.07/0.12, P=0.035). In nondiabetic recipients during the first posttransplant year, hyperinsulinemia induced increments in CrCL. As this may herald future renal dysfunction, hyperinsulinemia should not be ignored as a potential target in this population.
  Transplantation 02/2009; 87(2):274-9. · 4.00 Impact Factor
• Article: Unmasking glucose metabolism alterations in stable renal transplant recipients: a multicenter study.

  Patricia Delgado, Juan Manuel Diaz, Irene Silva, José M Osorio, Antonio Osuna, Beatriz Bayés, Ricardo Lauzurica, Edgar Arellano, Jose Maria Campistol, Rosa Dominguez, Carlos Gómez-Alamillo, Meritxell Ibernon, Francisco Moreso, Rocio Benitez, Ildefonso Lampreave, Esteban Porrini, Armando Torres
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  ABSTRACT: Emerging information indicates that glucose metabolism alterations are common after renal transplantation and are associated with carotid atheromatosis. The aims of this study were to investigate the prevalence of different glucose metabolism alterations in stable recipients as well as the factors related to the condition. A multicenter, cross-sectional study was conducted of 374 renal transplant recipients without pre- or posttransplantation diabetes. A standard 75-g oral glucose tolerance test was performed. Glucose metabolism alterations were present in 119 (31.8%) recipients: 92 (24.6%) with an abnormal oral glucose tolerance test and 27 (7.2%) with isolated impaired fasting glucose. The most common disorder was impaired glucose tolerance (17.9%), and an abnormal oral glucose tolerance test was observed for 21.5% of recipients with a normal fasting glucose. By multivariate analysis, age, prednisone dosage, triglyceride/high-density lipoprotein cholesterol ratio, and beta blocker use were shown to be factors related to glucose metabolism alterations. Remarkably, triglyceride levels, triglyceride/high-density lipoprotein cholesterol ratio, and the proportion of recipients with impaired fasting glucose were already higher throughout the first posttransplantation year in recipients with a current glucose metabolism alteration as compared with those without the condition. Glucose metabolism alterations are common in stable renal transplant recipients, and an oral glucose tolerance test is required for its detection. They are associated with a worse metabolic profile, which is already present during the first posttransplantation year. These findings may help planning strategies for early detection and intervention.
  Clinical Journal of the American Society of Nephrology 06/2008; 3(3):808-13. · 5.23 Impact Factor
• Article: Prediabetes in patients receiving tacrolimus in the first year after kidney transplantation: a prospective and multicenter study.

  Esteban Porrini, Jose Manuel Moreno, Antonio Osuna, Rocio Benitez, Ildefonso Lampreabe, Juan Manuel Diaz, Irene Silva, Rosa Domínguez, Julio Gonzalez-Cotorruelo, Beatriz Bayes, Ricardo Lauzurica, Meritxell Ibernon, Francisco Moreso, Patricia Delgado, Armando Torres
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  ABSTRACT: Tacrolimus-based immunosuppression, the most widely used regimen in kidney transplantation, increases the risk of new onset diabetes after transplantation (NODAT). However, the prevalence, evolution and risk factors of different prediabetic alterations: impaired fasting glucose, impaired glucose tolerance, and provisional diabetes, have not been established. In this multicenter and prospective study we evaluated 154 nondiabetic kidney transplant recipients receiving tacrolimus, mycophenolate mofetil and low dose steroids. An oral glucose tolerance test was performed 3 and 12 months after transplantation and prediabetes was defined by American Diabetes Association criteria. Prediabetes was highly prevalent and showed little variation between 3 and 12 months (36% and 33%, respectively). Impaired glucose tolerance was the most frequent abnormality observed (23% and 25%, respectively) observed. In addition, 20% of recipients showed NODAT by 1 year. Multivariate analysis showed that age (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.004-1.14), pretransplant body mass index (OR: 1.3, CI: 1.09-1.6) and triglyceride/high density lipoprotein-cholesterol ratio, a marker of insulin resistance, (OR: 1.4, CI: 1.05-1.9) were independent risk factors for prediabetes. One in two recipients with tacrolimus-based immunosuppresion showed prediabetes or NODAT by 1 year posttransplantation when properly investigated. Older age and high pretransplant body mass index and triglyceride/high density lipoprotein-cholesterol ratio were risk factors for prediabetes. These findings may help applying early interventions to prevent the disorder.
  Transplantation 05/2008; 85(8):1133-8. · 4.00 Impact Factor