Unexpectedly high prevalence of pretransplant abnormal glucose tolerance in pediatric kidney transplant recipients

Shishido, Seiichirou; Sato, Hiroyuki; Asanuma, Hiroshi; Shindo, Masahito; Hataya, Hiroshi; Ishikura, Kenji; Hamasaki, Yuko; Goto, Miwa; Ikeda, Masahiro; Honda, Masashi

doi:10.1111/j.1399-3046.2006.00459.x

Cited by 18 publications

(25 citation statements)

References 29 publications

(38 reference statements)

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“…The majority of pediatric studies have demonstrated a high prevalence of insulin resistance ranging from 16 to 47% in patients with CKD [10,11,34]. In contrast, a few pediatric studies have demonstrated inadequacy in both early-phase and late-phase insulin secretion in end stage renal disease [12,13]. Our study demonstrates that the pre-dialysis patients had a high prevalence of insulin resistance of 35%.…”

Section: Discussionmentioning

confidence: 64%

“…Although most studies performed on pediatric patients have focused on post-transplant patients, a few studies have shown that up to 45% of CKD patients exhibit glucose intolerance [13,29]. Abnormalities in glucose and insulin metabolism in uremia are mainly associated with the accumulation of "uremic toxins", vitamin D deficiency, metabolic acidosis, anemia, and inflammation [30].…”

Section: Discussionmentioning

confidence: 99%

“…Most pediatric studies have focused on insulin resistance caused by CKD during childhood, and the hypothesis has been that insulin resistance may be an important risk factor contributing to premature atherosclerosis [10,11]. On the other hand, there are only a limited number of published studies evaluating abnormalities in glucose metabolism in pre-dialyzed and dialyzed children [12][13][14]. In recent years, these abnormalities have become the focus of attention in pediatric renal transplant recipients because of the increasing incidence of new-onset DM after transplantation [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Glucose intolerance: is it a risk factor for cardiovascular disease in children with chronic kidney disease?

et al. 2011

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A total of 66 children and adolescents with chronic kidney disease (CKD) (20 pre-dialysis patients and 46 chronic dialysis patients) were evaluated to address the prevalence of abnormalities in glucose and insulin metabolism and their association with cardiovascular disease. Glucose intolerance was assessed using an oral glucose tolerance test; insulin resistance was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR). Carotid artery intima-media thickness (IMT) and left ventricular hypertrophy (LVH) were examined as early markers of cardiovascular disease. Thirty-four patients (7 pre-dialysis, 27 dialysis) exhibited an abnormal glucose tolerance; however, ten patients (7 pre-dialysis, 3 dialysis) were insulin-resistant. Height-specific standard deviation scores of carotid artery IMT were above normal in three of the pre-dialysis patients (15%) and in 34 of the dialysis patients (74%). LVH was present in seven pre-dialysis (35%) and 34 dialysis patients (74%). In addition, two of the pre-dialysis patients (10%) and 18 of the dialysis patients (39%) had severe LVH. The prevalence of both increased carotid artery IMT and LVH were similar in patients with or without glucose intolerance in both groups, but severe LVH was more prevalent in pre-dialysis patients with glucose intolerance (p = 0.042). The multivariate analyses showed that neither carotid artery IMT nor LVM index was predicted by serum glucose levels or HOMA-IR. In conclusion, children with CKD are at a high risk of glucose intolerance and also have a greater risk of subclinical cardiovascular disease (CVD). However, the presence of glucose intolerance does not appear to be an independent risk factor for increased carotid artery IMT or LVH.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Glucose intolerance: is it a risk factor for cardiovascular disease in children with chronic kidney disease?

et al. 2011

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“…Araştırmacılar, HOMA-IR'ye dayalı hiperinsülinemi ve insülin direncinin hafif-orta böbrek yetersizliği olan yetişkinlerde görüldüğünü göster-mişlerdir. [15][16][17][18][19] Bizim çalışmamızda da, hem TNF-α düzeyleri hem de insülin direnci KBY'li hastalarda sağlıklı kontrollere göre daha yüksek tespit edilmiştir (p< 0,001).…”

Section: Discussionunclassified

Relationship Between Serum Tumor Necrosis Factor-Alpha Levels and Insulin Resistance in Patients with Chronic Renal Failure

Ulaş¹,

Baştürk²,

Şakacı³

et al. 2012

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T A Am ma aç ç: : Kronik böbrek yetersizliği, sitokin düzensizliğinin olduğu kronik mikroenflamatuar bir süreçtir ve artmış insülin direnci de bu hastalarda bilinen bir durumdur. Tüber nekroz faktörü (TNF)-α da proinflamatuar bir sitokindir ve bunun kronik böbrek yetersizliği hastalarında artmış olduğu bazı çalışmalarda gösterilmiştir. Biz de bu çalışmayı, kronik böbrek yetersizliği hastalarında serum TNF-α düzeylerini, insülin direnci değerlerini ve bunların birbirleriyle olan ilişkisini araştır-mak amacıyla planladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya 15'i kadın, kronik böbrek yetersizliği olan 30 hasta (grup 1), kontrol grubu olarak 16'sı kadın 30 sağlıklı kişi (grup 2) olacak şekilde, toplam 60 hasta alındı. Hastalarda serum kreatinin, glomerüler filtrasyon hızı, TNF-α, açlık kan şekeri, açlık insülin düzeyleri çalışıldı ve HOMA-IR düzeyleri hesaplandı. B Bu ul lg gu ul la ar r: : Glomerüler filtrasyon hızı değerleri ortalamaları grup 1 için 42,05 ± 24,60 ml/dk ve grup 2 için 106,67 ± 17,10 ml/dk, TNF-α değerleri sırasıyla grup 1 için 57,65 ± 42,2 pg/ml ve grup 2 için 18,25 ± 7,90 pg/ml olarak HOMA-IR değerleri grup 1 için 3,71 ± 2,56 ve grup 2 için 2,37 ± 1,45 olarak saptandı. Grup 1 ve grup 2'nin HOMA-IR ve TNF-α düzeyleri sırasıyla karşılaştırıldığında istatistiksel olarak anlamlı fark saptandı (p< 0,01) (p< 0,001). Ancak TNF-α ile HOMA-IR'nin ikili korelasyonunda negatif veya pozitif yönlü ilişki saptanamadı (r= 0,091, p= 0,634). Yapılan regresyon analizinde TNF-α kronik böbrek yetersizliğinde bağımsız bir değişken olarak tespit edildi (p= 0,010). S So on nu uç ç: : Bu çalışmada, kronik böbrek yetersizliği olgularında insülin direnci bulunduğu ve dolaşımdaki TNF-α düzeyinin böbrek yetersizliği olmayan kontrollere göre daha yüksek olduğu fakat TNF-α'nın insülin direncine etki etmediği tespit edilmiştir.A An na ah ht ta ar r K Ke el li im me el le er r: : İnsülin direnci; böbrek yetmezliği, kronik; tümör nekroze edici faktör-alfa A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Chronic renal failure is a chronic microinflammatory process of cytokine dysregulation and increased insulin resistance is a known concept in these patients. Tumor necrosis factor (TNF)-α is a proinflammatory cytokine and has been shown to increase in chronic renal failure patients in some studies. We planned this study to investigate TNF-α levels, insulin resistance values and interrelations in chronic renal failure patients. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A total of 60 subjects of whom 30 had chronic renal failure (15 females-group 1) and 30 were healthy controls (16 females-group 2) were included in the study. Serum creatinine, glomerular filtration rate levels, TNF-α, fasting plasma glucose, fasting insulin levels were studied and HOMA-IR was calculated. R Re es su ul lt ts s: : Mean values of glomerular filtration rate were detected as follows; group 1: 42.05 ± 24.60 ml/min and group 2: 106.67 ± 17.10 ml/min, TNF-α values were found as group1:57.65 ± 4...

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“…Apart from causing CVD, they also have direct renal damaging effects [12] . However, apart from one previous study in mild to moderate pediatric CKD [14] , the insulin levels and insulin resistance in the pediatric CKD population has previously only been described in a few small studies of adolescents with severe renal failure [15][16][17][18][19] . Recently, they have also been found to be linked to malnutrition [20,21] and inflammation [14,22] , two other well-known cardiovascular risk factors.…”

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confidence: 99%

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

Lindblad¹,

Axelsson²,

Bárány³

et al. 2008

Blood Purif

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Background/Aims: Pediatric chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease. Still, hyperinsulinemia and insulin resistance, common cardiovascular risk factors, are not extensively investigated in children with CKD. We hypothesize that insulin abnormalities are present also in pediatric mild to moderate CKD, and associated with inflammation and malnutrition. Methods: We enrolled 26 children with CKD, and 34 healthy controls for analyses of blood samples and body composition. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR). Results: The patients had higher insulin levels and HOMA-IR compared to the controls (p < 0.01 and p < 0.005), and they correlated inversely with estimated glomerular filtration rate (rho = –0.52, p < 0.01; rho = –0.37, p = 0.08). No association was found with inflammation or malnutrition. Conclusion: High insulin levels and HOMA-IR appear to be common in pediatric CKD patients, already in mild to moderate renal failure. We hypothesize that hyperinsulinemia and insulin resistance alone might be important risk factors for cardiovascular disease in children with CKD.

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Unexpectedly high prevalence of pretransplant abnormal glucose tolerance in pediatric kidney transplant recipients

Cited by 18 publications

References 29 publications

Glucose intolerance: is it a risk factor for cardiovascular disease in children with chronic kidney disease?

Glucose intolerance: is it a risk factor for cardiovascular disease in children with chronic kidney disease?

Relationship Between Serum Tumor Necrosis Factor-Alpha Levels and Insulin Resistance in Patients with Chronic Renal Failure

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

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