Review article: The role of adipose tissue in uraemia‐related insulin resistance

Abstract

SUMMARY:Adipose tissue is no longer considered to be an inert tissue of which function is to store fat. It actively secretes a number of biologic active compounds that are involved in the regulation of many processes like food intake, energy expenditure, metabolism homeostasis, immunity and blood pressure homeostasis. General metabolism alteration in patients with chronic kidney disease has a profound impact on biology of adipocytes. Chronic renal failure is a pathological condition, of which two major hallmarks are chronic inflammation and insulin resistance. In uraemic patients, adipose tissue became an important source of molecules that are responsible, at least in part, for the metabolic disturbances seen in these patients. Some of these molecules act as pro-inflammatory agents contributing to the maintenance and enhancement of the chronic inflammatory response. These pro-inflammatory molecules, along with other molecules secreted by the adipose tissue, have a central position in the aetiology of uraemia-associated insulin resistance. In this review, we intend to summarize some aspects of the biology of adipokines in uraemia, with emphasis on the link between these molecules and insulin resistance.

Apelin and nutritional status in children on dialysis

“…6,7 In uremic milieu, due to reduced renal clearance of adipokines, adipose tissue becomes a significant contributor to increased systemic inflammation and uremic anorexia. 8,9 Apelin is a novel adipocytokine, also expressed in kidney, heart, central nervous system and endothelium. It was identified as the endogenous ligand of an orphan G proteincoupled receptor (APJ) which bears closest identity to the angiotensin II type 1 receptor (AT-1).…”

Growth hormone in chronic renal disease

“…It results in enhanced thermogenesis, weight loss, and improved insulin sensitivity. It is increased in patients with renal dysfunction undergoing dialysis[3536] and although the exact mechanism of its effect on energy metabolism is debated, it clearly has an important role in uremic cachexia.Resistin: Is an adipokine produced by macrophages that has shown to contribute to insulin resistance and development of white adipose tissue with elevated plasma free fatty acids, in preclinical studies. Elevated resistin has been associated with renal impairment and inflammation.…”

“…Although its exact mechanism on energy metabolism is debated in humans, it is believed to bear a significant role in energy intake. [3637]Ghrelin: Has shown to positively correlate to body mass index (BMI) and fat mass in patients with chronic kidney disease. Its administration has shown to increase energy intake and is being explored as a possible therapeutic option in the future.…”

“…It results in enhanced thermogenesis, weight loss, and improved insulin sensitivity. It is increased in patients with renal dysfunction undergoing dialysis[3536] and although the exact mechanism of its effect on energy metabolism is debated, it clearly has an important role in uremic cachexia.…”

“…Although its exact mechanism on energy metabolism is debated in humans, it is believed to bear a significant role in energy intake. [3637]…”