BACKGROUND: Kidney transplantation is the preferred treatment for patients with end-stage renal disease, significantly preserving kidney function and patient quality of life. However, post-transplant diabetes mellitus (PTDM) is a common complication, occurring in approximately one-third of renal transplant recipients. This study aims to evaluate the role of pulse wave parameters in predicting PTDM and to identify other pre-transplant risk factors. METHODS: This prospective cohort study included 105 patients on the kidney transplant waiting list from 2017 to 2022. Exclusion criteria included any pre-existing diabetes mellitus. Patients underwent physical examinations, laboratory analyses, and pulse wave analysis before transplantation and one year post-transplant. PTDM diagnosis followed International Consensus Guidelines. Data were analyzed using Wilcox test, Bonferroni correction, May-Whitney U-test, and Fisher's exact test, with p < 0.05 considered statistically significant. RESULTS: Post-transplant, 21% of patients were diagnosed with PTDM, increasing to 35% 3months post-transplant and 43% at one year post-transplant. Significant findings included: Pre-transplat risk factors for developing PTDM: Proteinuria (p = 0.037, OR = 3.942) and perioperative hyperglycemia (p = 0.003, OR = 4.219 at 3 months; p = 0.001, OR = 4.571 at 1 year). Pulse wave parameters for developing PTDM: Pre-transplant Aortic PP > 45 mmHg (AUC = 0.757) and PWV > 8.5 m/s (AUC = 0.730) were strong predictors of the development of PTDM after 3 months (p < 0.0001). Moreover, we found significant improvements in aortic pulse pressure (Aortic PP) and pulse wave velocity (PWV) post-transplant (p < 0.0001). CONCLUSION: Our study confirms that pulse wave parameters, such as Aortic PP and PWV, are significant predictors of PTDM in kidney transplant recipients (KTR). These findings support incorporating pulse wave analysis into routine pre-transplant evaluations to identify high-risk patients. Additionally, monitoring these parameters post-transplant may aid in early intervention and prevention of PTDM, ultimately improving patient outcomes. TRIAL REGISTRATION: Ethical approval was obtained from the Ethics Committee of Medical faculty and University Hospital Olomouc (approval no. 94/15).

• Klíčová slova
• Aortic pulse pressure, Cardiovascular complications., Kidney transplantation, Post-transplant diabetes mellitus, Pulse wave analysis, Pulse wave velocity,
• MeSH
• analýza pulzové vlny * MeSH
• chronické selhání ledvin * chirurgie   MeSH
• diabetes mellitus * etiologie   diagnóza   patofyziologie   epidemiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace * diagnóza   patofyziologie   etiologie   epidemiologie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• transplantace ledvin * škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Diabetes is one of the main risk factors for vascular damage, including endothelial dysfunction and arterial stiffness. The aim of this study was to compare selected parameters of vascular damage in patients with type 2 diabetes (T2D) in different age categories and to determine their relationship to indicators of glycometabolic control. A total of 160 patients with T2D were included in this cross-sectional study. They were divided into four age quartiles (with mean ages of 42.1 ± 4.5, 51.6 ± 1.4, 59.2 ± 3.0, and 69.8 ± 3.8, respectively). All subjects were evaluated for indicators of glycometabolic control and for arterial stiffness parameters along with markers of endothelial damage-tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and von Willebrand factor (vWF). The oldest compared to the youngest participants showed significantly increased parameters of arterial stiffness (augmentation pressure 13.4 ± 8.6 vs. 6.7 ± 4.4 mm Hg, augmentation index 26.2 ± 11.3 vs. 19.6 ± 9.2 mm Hg, aortic pulse pressure 47.7 ± 17.1 vs. 33.7 ± 10.4 mm Hg, and pulse wave velocity 11.9 (10.1-14.3) vs. 8.2 (7.7-9.8) m/s) despite having similar glycometabolic control. Arterial stiffness parameters were mainly associated with age and blood pressure. Age and systolic blood pressure were major determinants of arterial stiffness regardless of glycometabolic control. The oldest patients also had the highest levels of vWF (153.7 ± 51.9 vs. 121.7 ± 42.5 %) but the lowest levels of PAI-1 (81.8 ± 47.5 vs. 90.0 ± 44.9 ng/mL). Markers of endothelial dysfunction correlated with metabolic parameters, but did not correlate with arterial stiffness. Age and systolic blood pressure are major determinants of arterial stiffness in patients with T2D regardless of glycometabolic control, whereas an unfavorable metabolic profile is mainly related to endothelial dysfunction. These results suggest a differential contribution of cardiometabolic risk factors to vascular damage in T2D patients over their lifetime.

• Klíčová slova
• arterial stiffness, elderly, plasminogen activator inhibitor-1, tissue plasminogen activator, type 2 diabetes, von Willebrand factor,
• Publikační typ
• časopisecké články MeSH