Insulin Resistance as a Predictor of Cardiovascular Disease in Patients on peritoneal dialysis

Li, Yun; Zhang, Lihua; Gu, Yong; Hao, Chuan‐Ming; Zhu, Tao

doi:10.3747/pdi.2012.00037

Cited by 40 publications

(39 citation statements)

References 38 publications

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“…The few studies that have calculated HOMA-IR in PD patients lack any standardization of PD prescription concerning the last dwell period, before collecting blood to analyze insulin and glucose (9,25). We standardized these procedures not only in a fasting state, but also after the overnight dwell with 1.36% glucose solution, before the PET.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of overweight and obese patients is widely prevalent in contemporary PD populations (5,6), although there is much controversy about the major role of peritoneal glucose absorption on body fat accumulation over time (7,8). A single study has evidenced that insulin resistance evaluated by homeostasis model assessment (HOMA-IR) is a predictor of cardiovascular disease in PD patients (9); however, the specific role of peritoneal glucose absorption, small-solute transport, or obesity were not addressed.…”

Section: Introductionmentioning

confidence: 99%

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Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Bernardo

Oliveira

Santos³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Insulin resistance has been associated with cardiovascular disease in peritoneal dialysis patients. Few studies have addressed the impact of fast transport status or dialysis prescription on insulin resistance. The aim of this study was to test whether insulin resistance is associated with obesity parameters, peritoneal transport rate, and glucose absorption.Design, setting, participants, & measurements Insulin resistance was evaluated with homeostasis model assessment method (HOMA-IR), additionally corrected by adiponectin (HOMA-AD). Enrolled patients were prevalent nondiabetics attending at Santo António Hospital Peritoneal Dialysis Unit, who were free of hospitalization or infectious events in the previous 3 months (51 patients aged 50.4615.9 years, 59% women). Leptin, adiponectin, insulin-like growth factor-binding protein 1 (IGFBP-1), and daily glucose absorption were also measured. Lean tissue index, fat tissue index (FTI), and relative fat mass (rel.FM) were assessed using multifrequency bioimpedance. Patients were categorized according to dialysate to plasma creatinine ratio at 4 hours, 3.86% peritoneal equilibration test, and obesity parameters.Results Obesity was present in 49% of patients according to rel.FM. HOMA-IR correlated better with FTI than with body mass index. Significant correlations were found in obese, but not in nonobese patients, between HOMA-IR and leptin, leptin/adiponectin ratio (LAR), and IGFBP-1. HOMA-IR correlated with HOMA-AD, but did not correlate with glucose absorption or transport rate. There were no significant differences in insulin resistance indices, glucose absorption, and body composition parameters between fast and nonfast transporters. A total of 18 patients (35.3%) who had insulin resistance presented with higher LAR and rel. FM (7.3 [12.3, interquartile range] versus 0.7 [1.4, interquartile range], P,0.001, and 39.4610.1% versus 27.2611.5%, P=0.002, respectively), lower IGFBP-1 (8.267.2 versus 21.0616.3 ng/ml, P=0.002), but similar glucose absorption and small-solute transport compared with patients without insulin resistance. FTI and LAR were independent correlates of HOMA-IR in multivariate analysis adjusted for glucose absorption and small-solute transport (r=0.82, P,0.001).Conclusions Insulin resistance in nondiabetic peritoneal dialysis patients is associated with obesity and LAR independent of glucose absorption and small-solute transport status. Fast transport status was not associated with higher likelihood of obesity or insulin resistance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Bernardo

Oliveira

Santos³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…This was primarily done to help with logistical aspects and ease of administration. The study was powered based on published data in a PD study (22)(23)(24) whereas we observed a higher than expected SD for HOMA-IR (2,24). Accordingly, we might have had a Type II error when assessing our primary outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Certain metabolic abnormalities seen in CKD such as insulin resistance are shown to be independent predictors of cardiovascular mortality in non-diabetic maintenance dialysis patients (1,2). Peritoneal dialysis (PD) patients are considered to be at increased risk for insulin resistance (3), presumably due to the extra glucose load from the dialysate required for ultrafiltration (4,5) although data are scarce.…”

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confidence: 99%

Ketoacid Supplementation Partially Improves Metabolic Parameters in Patients on Peritoneal Dialysis

Dong

et al. 2015

Perit Dial Int

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♦ Background: A low protein diet supplemented with ketoacids has been shown to improve the metabolic profile, including insulin resistance, in patients with chronic kidney disease (CKD), but whether ketoacids alone exert similar effects is unknown. In this prospective randomized controlled trial, we aimed to evaluate the effects of ketoacid supplementation on insulin resistance, systemic inflammation, oxidative stress and endothelial dysfunction among 100 CKD patients undergoing peritoneal dialysis (PD). ♦ Methods: Patients from one Chinese PD center were randomly assigned to take ketoacids (12 tablets per day) (n = 50) versus a control group (n = 50) for 6 months in an open-label parallelarm design. Daily protein intake of 0.8 -1.2 g/kg/d and daily energy intake of 25 -35 kcal/kg/d was prescribed to both groups. Insulin resistance was evaluated using homeostatic model assessment (HOMA-IR) index as the primary outcome. We assessed systemic inflammation using high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6), oxidative stress using plasma oxidized low density lipoprotein (oxLDL), adipokines using leptin and adiponectin and endothelial dysfunction using serum soluble intercellular adhesion molecule-1 (sICAM) and soluble vascular adhesion molecule-1 (sVCAM) as secondary outcomes. ♦ Results: There were no significant differences in baseline characteristics between the 2 groups except a slightly higher age in patients assigned to the intervention. A total of 89% of participants completed the 6-month intervention. There was no significant difference in the change of HOMA-IR values from baseline between groups after adjusting for baseline age, gender, body mass index and HOMA-IR. For secondary outcomes, hs-CRP varied significantly between groups (p = 0.02), increasing over time for the control group while remaining stable for the ketoacid group. Similarly, the leptin/adiponectin ratio (LAR) differed between groups (p < 0.001), remaining stable in the ketoacid group but increasing in the control group. ♦ Conclusion: Ketoacid therapy administered for 6 months had no effect on HOMA-IR but resulted in improvements in hs-CRP and LAR, suggesting metabolic benefit. Future studies are needed to confirm these results and any potential benefit in vascular health of PD patients.

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“…Disorders associated with hyperleptinemia such as obesity and insulin resistance are major risk factors for cardiovascular disease [28] . Enhanced chronic systemic inflammation and reduced insulin sensitivity are often associated in patients with chronic renal disease, contributing to cardiovascular morbidity and mortality in these patients [29] .…”

Section: E P T I N I N a T H E R O S C L E R O S I S A N D Cardiovamentioning

confidence: 99%

Which is the Role of Leptin on Patients in the End Stage of Renal Disease?

Raikou

2015

Journal of Nephrology Research

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family of cytokines, related to diminished food intake. Since leptin is mainly secreted by adipose tissue, serum leptin levels are directly proportional to adipocyte mass. Apart from metabolism, leptin has systemic effects including regulation of angiogenesis, wound healing, lipolysis, blood pressure homeostasis, reproduction, hematopoiesis and immune function [2,3] . The current studies provide evidence that the real role of leptin on the patients in end stage of renal disease is complicated rather than clear. LEPTIN, INFLAMMATION, MALNUTRITION AND INSULIN RESISTANCEIt has been already recognized that a substantial number of patients with end-stage renal disease have serologic evidence of an activated inflammatory state [4] . Previously, the leptin receptor has been identified on endothelial cells, and leptin has been reported to promote both angiogenesis and inflammation [5] . Leptin modifies the systemic inflammatory response and the inflammatory microenvironement in renal disease may be associated with elevated expression of leptin gene [6] . However, there is a discrepancy for the relationship of leptin levels with chronic inflammation and it has been supported that leptin may be a negative acute phase protein in chronic hemodialysis patients [7] . On the other hand, leptin suppresses appetite and increases energy expenditure, playing a homeostatic role in the regulation of food intake and in maintaining body composition in general population [8] . In patients with end-stage renal disease malnutrition and hypoalbuminemia are common and powerful predictors of morbidity and mortality in this population [9] . One potential relationship between malnutrition and inflammation in renal disease patients is appetite suppression and the link between inflammation and anorexia may be through the leptin [10] . However, it has been already supported that inflammation is unlikely to reduce appetite causing malnutrition in dialysis patients through a leptin-mediated mechanism, because leptin is a negative rather than a positive acute phase protein in this population of patients [7] . Also, recent study reported that leptin levels were elevated in ESRD patients with normal and mild malnutrition, ABSTRACTLeptin is a small peptide hormone (16 kDa), a product of the obesity gene (Ob), and is mainly synthesized and secreted by adipocytes.In this review paper the main points of the leptin role on the end stage of renal disease is out lined.

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Insulin Resistance as a Predictor of Cardiovascular Disease in Patients on peritoneal dialysis

Cited by 40 publications

References 38 publications

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Ketoacid Supplementation Partially Improves Metabolic Parameters in Patients on Peritoneal Dialysis

Which is the Role of Leptin on Patients in the End Stage of Renal Disease?

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