Homeostatic Model Assessment in Kidney Transplantation

Introduction: Long-term kidney transplantation survival has been limited to cardiovascular-disease-associated death, which may be related to insulin resistance. The aim of this study is to evaluate the association between homeostatic model assessment (HOMA)and renal graft function. Materials and methods: From January 2013 to March 2015, 55 nondiabetic kidney recipients were reviewed retrospectively with their baseline fasting serum insulin and glucose levels as the basis the following indexes: 1. HOMA insulin resistance (HOMA-IR), 2. HOMA-β, and 3. insulin-glucose ratio (IGR). These patients were divided into 2 groups according to their HOMA indexes, and the serum creatinine (Cr)and estimated glomerular filtration rate (eGFR)were analyzed on the basis of every 6 months up to 3 years after kidney transplantation. Finally, we evaluate whether these HOMA indexes are a determinant factor of eGFR at post-transplant 1 year, 2 year, and 3 year. Results: There was no persisting difference in Cr and eGFR between high- and low-HOMA indexes except that the Cr and eGFR difference by HOMA-β stratification increased with time and became nearly significant at 3 years after transplantation. Further univariate and multivariate linear regression models showed no factor affected the 1-year eGFR independently, while weight affected the 2-year eGFR and only HOMA-β affected the 3-year eGFR independently. Conclusion: In non-diabetic kidney recipients, the eGFR difference between high- and low-HOMA-β patients increases over time. In multivariate linear regression, HOMA-β, but not HOMA-IR nor IGR, has independent significant association with eGFR at 3 years after transplantation.