Hyperinsulinemia and Insulin Resistance, Early Cardiovascular Risk Factors in Children with Chronic Kidney Disease

Lindblad, Ylva Tranæus; Axelsson, Jonas; Bárány, Peter; Celsi, Gianni; Lindholm, Bengt; Qureshi, Abdul Rashid; Carrea, Alba; Canepa, Alberto

doi:10.1159/000167799

Cited by 12 publications

(4 citation statements)

References 80 publications

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“…Circulating levels of insulin keep an inverse relationship with those of IGFBP-1 and IGFBP-2 in children with nutritional disorders (22,23). Thus, the association of high concentrations of IGFBP-1 and IGFBP-2 with normal values of serum insulin suggests that the status of insulin resistance reported in children with CRF (24,25) is present in well-nourished infants with CRF and is not modified by GH therapy.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Growth After 1 Year of Growth Hormone Therapy in Well-Nourished Infants with Growth Retardation Secondary to Chronic Renal Failure

Santos¹,

Moreno²,

Neto³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Our aim was to evaluate the growth-promoting effect of growth hormone (GH) treatment in infants with chronic renal failure (CRF) and persistent growth retardation despite adequate nutritional and metabolic management.Design, setting, participants, & measurements: The study design included randomized, parallel groups in an open, multicenter trial comparing GH (0.33 mg/kg per wk) with nontreatment with GH during 12 months. Sixteen infants who had growth retardation, were aged 12 ؎ 3 months, had CRF (GFR <60 ml/min per 1.73 m 2 ), and had adequate nutritional intake and good metabolic control were recruited from eight pediatric nephrology departments from Spain and Portugal. Main outcome measures were body length, body weight, bone age, biochemical and hormonal analyses, renal function, bone mass, and adverse effects.Results: Length gain in infants who were treated with GH was statistically greater (P < 0.05) than that of nontreated children (14.5 versus 9.5 cm/yr; SD score 1.43 versus ؊0.11). The GH-induced stimulation of growth was associated with no undesirable effects on bone maturation, renal failure progression, or metabolic control. In addition, GH treatment improved forearm bone mass and increased serum concentrations of total and free IGF-I and IGF-binding protein 3 (IGFBP-3), whereas IGF-II, IGFBP-1, IGFBP-2, GH-binding protein, ghrelin, and leptin were not modified.Conclusions: Infants with CRF and growth retardation despite good metabolic and nutritional control benefit from GH treatment without adverse effects during 12 months of therapy.

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Section: Discussionmentioning

confidence: 99%

Improvement in Growth After 1 Year of Growth Hormone Therapy in Well-Nourished Infants with Growth Retardation Secondary to Chronic Renal Failure

Santos¹,

Moreno²,

Neto³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…In addition, it was shown that short-term aerobic exercise improved stiffness index ␤ at least in part via increasing insulin sensitivity [31] . Insulin resistance develops inevitably in patients who have impaired renal function [32] , and a high prevalence of IR has been found in ESRD [33][34][35] . The gold standard method for IR is euglycemic glucose clamp technique, which is far too labor intensive.…”

Section: Discussionmentioning

confidence: 99%

Association between Insulin Resistance and Carotid Arterial Stiffness in Nondiabetic Hemodialysis Patients

Zhou

Yu²,

Jia³

et al. 2009

Blood Purif

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Background: Patients with end-stage renal disease are known to have insulin resistance and advanced arterial stiffness. The present study was undertaken to investigate whether insulin resistance was correlated with carotid arterial stiffness in hemodialysis patients. Methods: Eighty nondiabetic hemodialysis patients were recruited. Stiffness index β of the common carotid artery was assessed by ultrasound using echo-tracking system. Insulin resistance was evaluated by the homeostasis model assessment method (HOMA-IR). Serum albumin, lipid profile, calcium, phosphorus, intact parathyroid hormone, high-sensitivity C-reactive protein and oxidized low-density lipoprotein (ox-LDL) were also measured. Results: Patients with higher HOMA-IR levels had higher BMI, ox-LDL, and stiffness index β than patients with lower HOMA-IR levels. HOMA-IR was independently correlated with stiffness index β (β = 0.260, p = 0.016). BMI and ox-LDL were independent contributors to HOMA-IR. Conclusion: Insulin resistance assessed by HOMA-IR is closely associated with carotid arterial stiffness in nondiabetic hemodialysis patients.

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“…IR is present in patients with early CKD and progressively worsens as the disease progresses to end-stage renal disease. IR may participate in the occurrence and development of CKD through such mechanisms as a hyperinsulinemic reaction ( 14 ), induction of oxidative stress ( 15 ), activation of a sympathetic renin-angiotensin-aldosterone system ( 16 ), activation of inflammatory factors ( 17 ), and inhibition of insulin signaling pathway ( 18 ). Cheng HT al ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

A high triglyceride glucose index is associated with early renal impairment in the hypertensive patients

et al. 2022

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ObjectiveSerum β2-microglobulin (β2-MG) and serum cystatin C (CysC) are sensitive and reliable indicators of early renal impairment. Triglyceride glucose index (TyG) is an emerging vital indicator of insulin resistance and is associated with increased risk of hypertension. We aimed to analyze the relationship between TyG and early renal impairment in hypertensive patients.MethodsA retrospective analysis was performed on 881 hypertensive patients treated in Qinghai Provincial People, s Hospital from March 2018 to March 2021, their clinical data and corresponding laboratory index values were recorded, and the TyG index was calculated. According to the TyG index, the patients were divided into a low TyG (L-TyG) group (TyG ≤ 8.50, n=306), medium TyG (M-TyG) group (8.51≤TyG ≤ 8.94, n=281), and high TyG (H-TyG) group (TyG>8.95, n=294) in sequence by using tertiles. Then, according to serum β2-MG and CysC levels, they were divided into a normal renal function group (β2-MG ≤ 2.4 mg/L, n=700 and CysC ≤ 1.25mg/L, n=721) and a renal function injury group (β2-MG>2.4 mg/L, n=181, and CysC>1.25 mg/L, n=160). Multivariate linear regression analysis was used to analyze the influencing factors of serum β2-microglobulin and cystatin C. Multivariate Logistic regression was used to analyze the relationship between the TyG index and early renal impairment in hypertensive patients. The receiver operating characteristic curve (ROC) was used to determine the value of the TyG index in predicting early renal impairment in patients with hypertension.ResultAs the TyG index level increased, serum β2-MG and CysC levels also gradually increased. Multivariate linear regression analysis showed that TyG index was the influencing factor of serum β2-MG (B=0.060, P=0.007) and serum CysC (B=0.096, P<0.001). For every 1 standard deviation increase in the TyG index, the serum β2-MG and CysC increased by 0.06mg/L and 0.096mg/L, respectively. When compared to the normal group, the TyG level (8.91 ± 0.65 vs 8.64 ± 0.60, P<0.001) was higher in the renal impairment group with β2-MG>2.4 mg/L. The results of multivariate logistic regression analysis revealed that for every 1 standard deviation increase in the TyG index, the risk of early renal impairment in hypertensive patients increased 1.53 times (OR=1.53, 95%CI 1.006-2.303).The ROC curves showed that the TyG index was not superior to TG in predicting early renal impairment in hypertensive patients. the AUC values were 0.623 and 0.617, respectively. Then, when CysC>1.25 mg/L was used as the renal damage group, the level of TyG was still higher than that in the normal group (8.94 ± 0.67 and 8.64 ± 0.60, P<0.001). Multivariate Logistic regression analysis showed that for every 1 standard deviation increase in the TyG index, the risk of early renal impairment in hypertensive patients increased 2.82 times (OR=2.82, 95%CI 1.863-4.262). The ROC curves showed that the TyG index was not superior to TG in predicting early renal impairment in hypertensive patients. the AUC values were 0.629 and 0.626, respectively.ConclusionTyG index is an influential factor in serum β2-MG and CysC levels. The elevated TyG index levels are closely associated with the occurrence and development of early renal impairment in hypertensive patients, but it should be used cautiously in the prediction of early renal impairment.

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Hyperinsulinemia and Insulin Resistance, Early Cardiovascular Risk Factors in Children with Chronic Kidney Disease

Cited by 12 publications

References 80 publications

Improvement in Growth After 1 Year of Growth Hormone Therapy in Well-Nourished Infants with Growth Retardation Secondary to Chronic Renal Failure

Improvement in Growth After 1 Year of Growth Hormone Therapy in Well-Nourished Infants with Growth Retardation Secondary to Chronic Renal Failure

Association between Insulin Resistance and Carotid Arterial Stiffness in Nondiabetic Hemodialysis Patients

A high triglyceride glucose index is associated with early renal impairment in the hypertensive patients

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