Insulin Resistance in CKD

Leyking, Sarah; Fliser, Danilo

doi:10.2215/cjn.01290214

Cited by 37 publications

(32 citation statements)

References 23 publications

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“…In the present study, we found that a higher level of first-trimester BUN was significantly asso- sulphates, modification of gut microbiome, oxidative stress and inflammation. 7,26,27 Researchers further observed that beta-cell dysfunction induced by elevated levels of uraemic metabolite urea is an important contributor to impaired glucose homeostasis in CKD mice. 28 Furthermore, in human studies, Xie and colleagues recently had found that higher levels of BUN were associated with an increased risk of insulin use among people with diabetes.…”

Section: Discussionmentioning

confidence: 99%

First‐trimester blood urea nitrogen and risk of gestational diabetes mellitus

Peng¹,

Wang

Yu³

et al. 2020

J Cellular Molecular Medi

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Prior studies indicated that urea increased insulin resistance and higher blood urea nitrogen (BUN) was associated with incident diabetes mellitus. However, it remains unclear whether BUN during the first trimester of pregnancy increases risk of gestational diabetes mellitus (GDM). We aimed to investigate the association between first‐trimester BUN and risk of incident GDM. We conducted a prospective, multicenter cohort study of pregnant women. A total of 13 448 eligible pregnant women with measured first‐trimester BUN levels were included in this analysis. Logistic regression analysis was used to estimate the relationship between BUN and GDM. Discrimination and reclassification for GDM by BUN were analysed. A total of 2973 (22.1%) women developed GDM. Compared with the lowest quartile of BUN, the third and fourth quartiles were associated with increased risk of GDM (adjusted odds ratios 1.21 [95% CI 1.07‐1.37] and 1.50 [95% CI 1.33‐1.69], respectively, P for trend <.001). The addition of BUN to conventional factor model improved discrimination (C statistic 0.2%, P = .003) and reclassification (net reclassification index 14.67%, P < .001; integrated discrimination improvement 0.12%, P < .001) for GDM. In conclusion, higher BUN concentrations during the first trimester of pregnancy were associated with increased risk of GDM, suggesting that BUN could be a potential predictor for GDM.

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Section: Discussionmentioning

confidence: 99%

First‐trimester blood urea nitrogen and risk of gestational diabetes mellitus

Peng¹,

Wang

Yu³

et al. 2020

J Cellular Molecular Medi

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“…In particular, leptin accumulates to a much larger extent than adiponectin in CKD, thus altering the ratio of leptin to adiponectin to a great magnitude. This highly abnormal ratio may play a pivotal role in the IR and metabolic disorders observed in CKD …”

Section: Causesmentioning

confidence: 99%

“…This highly abnormal ratio may play a pivotal role in the IR and metabolic disorders observed in CKD. 13,18,19 CONSEQUENCES IR is likely to play a key role in the development of cardiometabolic complications and is associated with an increased risk of cardiovascular events and premature death. 20 Prospective data concerning the association between IR and clinical outcomes in CKD patients are, however, few and contradictory.…”

Section: Causesmentioning

confidence: 99%

Insulin resistance in chronic kidney disease

Carrero

2017

Nephrology

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ABSTRACT:This review provides an overview of insulin resistance (IR) in patients with chronic kidney disease (CKD). IR is a pathological state in which target tissues fail to respond normally to insulin. IR is understood as a consequence of CKD and its prevalence rises particularly in advanced CKD stages. Mechanisms leading to IR are complex and multifactorial, involving post-receptor signaling defects, unhealthy lifestyles, metabolic acidosis, inflammation, oxidative stress, vitamin D deficiency, anemia, and uremic toxicity, as shown by human and experimental studies over the last 30 years. Whereas hyperinsulinemic euglycemic clamp is the gold standard, it is unpractical at the bedside, and either estimated IR indices by fasting glucose or insulin and oral glucose tolerance tests (OGTT) provide satisfactory estimates of IR also in patients with CKD. IR is likely to play a key role in the development of cardiometabolic complications, but not all studies associate IR with the risk of cardiovascular events and death. Various interventions at the level of lifestyle modifications, adaptations in dialysis therapy (such as use of icodextrin based solutions) and pharmacological strategies such as thiazolidinediones or vitamin D therapy may improve IR in patient with CKD.

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“…The HOMA-IR derives an estimate of insulin sensitivity from the mathematical modeling of fasting plasma glucose and insulin concentrations. Both methods have been validated intensively [6,7].…”

Section: Selection and Description Of Participantsmentioning

confidence: 99%