Format

Send to

Choose Destination
BMC Nephrol. 2019 Feb 20;20(1):60. doi: 10.1186/s12882-019-1220-6.

Insulin resistance and chronic kidney disease progression, cardiovascular events, and death: findings from the chronic renal insufficiency cohort study.

Author information

1
Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA. Sarah.Schrauben@uphs.upenn.edu.
2
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA. Sarah.Schrauben@uphs.upenn.edu.
3
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.
4
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
5
Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
6
Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
7
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
8
Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA.
9
Department of Medicine, Tulane University School of Medicine, New Orleans, Lousiana, USA.
10
Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
11
Deparment of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA.
12
Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.

Abstract

BACKGROUND:

Insulin resistance contributes to the metabolic syndrome, which is associated with the development of kidney disease. However, it is unclear if insulin resistance independently contributes to an increased risk of chronic kidney disease (CKD) progression or CKD complications. Additionally, predisposing factors responsible for insulin resistance in the absence of diabetes in CKD are not well described. This study aimed to describe factors associated with insulin resistance and characterize the relationship of insulin resistance to CKD progression, cardiovascular events and death among a cohort of non-diabetics with CKD.

METHODS:

Data was utilized from Chronic Renal Insufficiency Cohort Study participants without diabetes (Nā€‰=ā€‰1883). Linear regression was used to assess associations with insulin resistance, defined using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The relationship of HOMA-IR, fasting glucose, hemoglobin A1c (HbA1c), and C-peptide with CKD progression, cardiovascular events, and all-cause mortality was examined with Cox proportional hazards models.

RESULTS:

Novel positive associations with HOMA-IR included serum albumin, uric acid, and hemoglobin A1c. After adjustment, HOMA-IR was not associated with CKD progression, cardiovascular events, or all-cause mortality. There was a notable positive association of one standard deviation increase in HbA1c with the cardiovascular endpoint (HR 1.16, 95% CI: 1.00-1.34).

CONCLUSION:

We describe potential determinants of HOMA-IR among a cohort of non-diabetics with mild-moderate CKD. HOMA-IR was not associated with renal or cardiovascular events, or all-cause mortality, which adds to the growing literature describing an inconsistent relationship of insulin resistance with CKD-related outcomes.

KEYWORDS:

Cardiovascular disease; Chronic kidney disease; Chronic renal insufficiency; Insulin resistance; Mortality

PMID:
30786864
PMCID:
PMC6383235
DOI:
10.1186/s12882-019-1220-6
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center