Open AccessInsulin Resistance, Inflammation, and Vascular Disease in Nondiabetic Predialysis Chronic Kidney Disease Patients
Author(s) -
Banerjee Debasish,
RecioMayoral Alejandro,
Chitalia Nihil,
Kaski JuanCarlos
Publication year - 2011
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20901
Subject(s) - medicine , insulin resistance , kidney disease , interquartile range , brachial artery , renal function , population , diabetes mellitus , gastroenterology , cardiology , endocrinology , insulin , blood pressure , environmental health
Background: Chronic kidney disease (CKD) is associated with high cardiovascular morbidity and mortality, which is not fully explained by traditional risk factors; hence, the interest in nontraditional risk factors such as inflammation and insulin resistance (IR). Though IR is shown in nondiabetic CKD, its association with vascular disease and inflammation in this population is unknown, and is what this study aims to investigate. Hypothesis: IR and inflammation are related to vascular disease in nondiabetic predialysis CKD patients. Methods: We studied carotid‐artery intima‐media thickness (IMT) and endothelial function (brachial artery flow mediated dilation [FMD]) in 35 nondiabetic predialysis patients with stage 3–5 CKD and 35 age‐ and gender‐matched controls. Insulin resistance was measured using the homeostasis model assessment for insulin resistance score (HOMA‐IR), inflammation by high‐sensitivity CRP (hsCRP), and their relationship with FMD and IMT. Results: Patients with CKD showed reduced FMD (3.34 ± 2.14% vs 5.27 ± 1.78%, P< 0.001) and increased IMT (0.78 ± 0.22 mm vs 0.64 ± 0.16 mm, P = 0.003) compared with controls. The CKD patients had a higher HOMA‐IR (2.20 ± 1.08 vs 1.13 ± 0.64, P< 0.001) and hsCRP (3.25 ± 5.47 mg/L vs 1.10 ± 1.85 mg/L [median ± interquartile range], P = 0.02). In the study population, HOMA‐IR was directly related to hsCRP. After adjusting for traditional risk factors, high HOMA‐IR and hsCRP were significantly related to decreased FMD (adjusted β = − 0.44, 95% confidence interval [CI]: − 1.55 to − 0.08, P = 0.003 and adjusted β = − 0.51, 95% CI: − 0.51 to − 0.15, P = 0.001) and increased IMT (adjusted β = 0.62, 95% CI: 0.54–1.90, P = 0.001 and adjusted β = 0.43, 95% CI: 0.08–0.57, P = 0.011), respectively. Conclusions: Subjects with systemic inflammation were more insulin‐resistant, and in nondiabetic predialysis CKD, IR and systemic inflammation were independently associated with endothelial dysfunction and atherosclerosis. © 2011 Wiley Periodicals, Inc. Dr. Debasish Banerjee and Dr. Alejandro Recio‐Mayoral are joint first authors. This study has been supported by grants awarded by the Spanish Society of Cardiology to Dr. A. Recio‐Mayoral and by the St. George's Charitable Foundation to Dr. D. Banerjee. The authors have no other funding, financial relationships, or conflicts of interest to disclose.