Insulin resistance in patients with chronic kidney disease.
BACKGROUND
It has been reported that insulin resistance appears at an earlier stage of chronic kidney disease (CKD). However, few data are available concerning what factors of metabolic abnormalities, such as apolipoprotein (Apo) profile or acidosis, might be associated with insulin resistance in patients with CKD.


METHODS
We used the hyperinsulinemic euglycemic glucose clamp technique to examine insulin sensitivity in patients without diabetes (n = 29) with different stages of renal function. Results were compared with those in healthy subjects (n = 10) and related to various affecting variables.


RESULTS
In healthy subjects, the glucose disposal rate (GDR) was 9.93 +/- 1.33 mg/kg/min. The GDR of patients with CKD (6.91 +/- 2.46 mg/kg/min) was significantly less than that of healthy subjects ( P < 0.01), which shows diminished insulin sensitivity in patients with CKD. There was a negative correlation between GDR and serum creatinine level ( r = -0.449; P < 0.05) and positive correlations between GDR and creatinine clearance ( r = 0.549; P < 0.01) and Apo A-1/B levels ( r = 0.396; P < 0.05). Of particular relevance is the observed close correlation between GDR and bicarbonate level, with an extremely high predictive value for degree of acidosis ( r = 0.611; P < 0.0005). Stepwise multivariate regression analysis selected bicarbonate (F = 13.28) and Apo A-1/B levels (F = 6.58) as independent contributing variables.


CONCLUSIONS
We found that insulin resistance correlated linearly with decline in renal function. Independent variables related to insulin resistance were bicarbonate and Apo A-1/B levels in patients with CKD.
Kobayashi
Shuzo
S
Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan. shuzo@shonankamakura.or.jp <shuzo@shonankamakura.or.jp>
Maesato
Kyoko
K
Moriya
Hidekazu
H
Ohtake
Takayasu
T
Ikeda
Toshio
T
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000502:physiology; D002908:Chronic Disease; D005215:Fasting / Q000097:blood / Q000502:physiology; D005260:Female; D015309:Glucose Clamp Technique / Q000379:methods; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D007674:Kidney Diseases / Q000097:blood* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000473:pathology; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D007328:Insulin