title: Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease.
abstract: Insulin resistance is closely associated with atherosclerosis and cardiovascular mortality in the general population. Patients with end-stage renal disease (ESRD) are known to have insulin resistance, advanced atherosclerosis, and a high cardiovascular mortality rate. We evaluated whether insulin resistance is a predictor of cardiovascular death in a cohort of ESRD. A prospective observational cohort study was performed in 183 nondiabetic patients with ESRD treated with maintenance hemodialysis. Insulin resistance was evaluated by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels at baseline, and the cohort was followed for a mean period of 67 mo. Forty-nine deaths were recorded, including 22 cardiovascular deaths. Cumulative incidence of cardiovascular death by Kaplan-Meier estimation was significantly different between subjects in the top tertile of HOMA-IR (1.40 to 4.59) and those in the lower tertiles of HOMA-IR (0.28 to 1.39), and the hazard ratio (HR) was 2.60 (95% confidence interval [CI], 1.12 to 6.01; P = 0.026) in the univariate Cox proportional hazards model. In multivariate Cox models, the positive association between HOMA-IR and cardiovascular mortality remained significant (HR, 4.60; 95% CI, 1.83 to 11.55; P = 0.001) and independent of age, C-reactive protein, and presence of preexisting vascular complications. Further analyses showed that the effect of HOMA-IR on cardiovascular mortality was independent of body mass index, hypertension, and dyslipidemia. In contrast, HOMA-IR did not show such a significant association with noncardiovascular mortality. These results indicate that insulin resistance is an independent predictor of cardiovascular mortality in ESRD.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Shinohara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.forename: Masanori
authors.initials: M
authors.lastname: Emoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Tahara
authors.forename: Hidenori
authors.initials: H
authors.lastname: Koyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Takami
authors.initials: T
authors.lastname: Miki
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tabata
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies