The prevalence of insulin resistance in nondiabetic nonobese patients with chronic kidney disease

Şit, Dede; Kadiroglu, Ali Kemal; Kayabaşı, Hasan; Yılmaz, Mehmet Emin

doi:10.1007/bf02850219

Cited by 32 publications

(22 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…38 The third one is insulin, of which circulating plasma levels have been found frequently elevated in patients with a reduced glomerular filtration rate. 39,40 The final one is a decreased brain NO availability reported in renal failure and potentially responsible for the renal disease-related sympathetic activation. 41 Our study has some limitations but also a clinical implication.…”

Section: Discussionmentioning

confidence: 99%

Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

et al. 2011

View full text Add to dashboard Cite

Abstract-Direct and indirect indices of neuroadrenergic function have shown that end-stage renal disease is characterized by a marked sympathetic overdrive. It is unknown, however, whether this phenomenon represents a peculiar feature of end-stage renal disease or whether it is also detectable in the early clinical phases of the disease. The study has been performed in 73 hypertensive patients, of which there were 42 (age: 60.7Ϯ1.8 years, meanϮSEM) with a stable moderate chronic renal failure (mean estimated glomerular filtration rate: 40.7 mL/min per 1.73 m 2 , MDRD formula) and 31 age-matched controls with a preserved renal function. Measurements included anthropometric variables, sphygmomanometric and beat-to-beat blood pressure, heart rate (ECG), venous plasma norepinephrine (highperformance liquid chromatography), and efferent postganglionic muscle sympathetic nerve activity (microneurography, peroneal nerve). For similar anthropometric and hemodynamic values, renal failure patients displayed muscle sympathetic nerve activity values significantly and markedly greater than controls (60.0Ϯ2.1 versus 45.7Ϯ2.0 bursts per 100 heartbeats; PϽ0.001). Muscle sympathetic nerve activity showed a progressive and significant increase from the first to the fourth quartile of the estimated glomerular filtration rate values (first: 41.0Ϯ2.7; second: 51.9Ϯ1.7; third: 59.8Ϯ3.0; fourth: 61.9Ϯ3.3 bursts per 100 heartbeats), the statistical significance (PϽ0.05) between groups being maintained after adjustment for confounders. In the population as a whole, muscle sympathetic nerve activity was significantly and inversely correlated with the estimated glomerular filtration rate (rϭϪ0.59; PϽ0.0001). Thus, adrenergic activation is a phenomenon not confined to advanced renal failure but already detectable in the initial phases of the disease. The sympathetic overdrive parallels the severity of the renal failure, state and, thus, it might participate, in conjunction with other factors, at the disease progression. (Hypertension. 2011;57:846-851.) Key Words: chronic renal failure Ⅲ microneurography Ⅲ sympathetic nervous system A dvanced renal failure is accompanied by a marked activation of sympathetic cardiovascular influences, as documented by the increase in the circulating plasma levels of norepinephrine, the elevated number of sympathetic neural bursts recorded in the peroneal nerve via the microneurographic technique, and the augmented oscillations in the high-frequency band of the heart rate power spectra. [1][2][3][4][5][6][7][8][9][10][11][12][13] Whether the sympathetic activation also characterizes the earlier clinical phases of the renal failure state is not clear, however. This is because in the few studies performed so far in patients with mild renal disease, the population sample was small, and the plasma levels of norepinephrine showed inconsistent changes. 11,12 Furthermore, in the 2 previously published studies that assessed sympathetic nerve traffic via microneurography, approximately half of the patients evaluated ...

show abstract

Section: Discussionmentioning

confidence: 99%

Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Sit et al [4] estimated IR at 48.3% in CKD patients. Unfortunately, there is no normal cut-off level for the HOMA-IR, the standard method for quantification of IR.…”

Section: Discussionmentioning

confidence: 99%

“…Further clinical studies in humans support the link between β-cell dysfunction and CKD [3]. On the other hand, several researchers have cited IR as a primary reason behind hyperglycemia in patients with CKD [4]. It is suggested that IR occurs early with minimal decrease in glomerular filtration rate (GFR) [5].…”

Section: Introductionmentioning

confidence: 99%

Susceptibility to Hyperglycemia in Patients with Chronic Kidney Disease

Shehab-Eldin

Zaki²,

Gazareen³

et al. 2008

Am J Nephrol

View full text Add to dashboard Cite

Background: Patients with chronic kidney disease (CKD) are susceptible to hyperglycemia. Aim: To study the prevalence of pre-diabetes in CKD patients and determine the contribution of insulin resistance (IR) versus β-cell dysfunction in patients with CKD. Methods: 45 consecutive nondiabetic CKD patients and 40 healthy subjects were included. Patients were divided into a normoglycemic (NG) and a pre-diabetic (PDM) group. IR was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and β-cell function was assessed by proinsulin/insulin ratio and β-cell%. Results: The prevalence of PDM was 40%. The prevalence of high HOMA-IR was 22.2 and 77.8% in the NG and PDM groups. Compared to NG patients, the PDM group showed higher fasting plasma glucose, HOMA-IR, insulin, and proinsulin, while the prevalence of β-cell dysfunction of 22.2% was lower than the 37% present in the NG group. Conclusion: Increased IR, rather than β-cell dysfunction, is the primary mechanism of PDM in CKD patients.

show abstract

“…Sit et al [16] evaluated the prevalence of IR in 89 nondiabetic nonobese patients with chronic kidney disease. At HOMA-IR cutoff 5.4, they reported IR in 48.3% of their chronic kidney disease patients [16] .…”

Section: Impaired Insulin Action In Uremiamentioning

confidence: 99%

“…At HOMA-IR cutoff 5.4, they reported IR in 48.3% of their chronic kidney disease patients [16] . In another study [17] , it was reported in 50% of such patients.…”

Section: Impaired Insulin Action In Uremiamentioning

confidence: 99%

Evidence for Increased Risk of Prediabetes in the Uremic Patient

Shehab-Eldin¹,

Ragheb²,

Klassen³

et al. 2007

Nephron Clin Pract

View full text Add to dashboard Cite

A prediabetic state is defined as a higher than normal blood glucose level but not yet high enough to meet the diagnosis of overt diabetes mellitus. While patients with advanced diabetic nephropathy are vulnerable to hypoglycemia, we believe that there is sufficient evidence that uremic nondiabetic patients are susceptible to hyperglycemia, which calls for more attention that uremia is a prediabetic state. It is, therefore, intriguing to identify these uremic factors which lead to prediabetes. Such a study may have significance to improve uremic patients’ outcomes. To raise the awareness of the uremic prediabetic state, this review will, therefore, elaborate on the analysis of factors important in the development of prediabetes in uremia and will delineate whether their modification leads to an improved patient outcome.

show abstract

The prevalence of insulin resistance in nondiabetic nonobese patients with chronic kidney disease

Cited by 32 publications

References 28 publications

Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

Susceptibility to Hyperglycemia in Patients with Chronic Kidney Disease

Evidence for Increased Risk of Prediabetes in the Uremic Patient

Contact Info

Product

Resources

About