title: Insulin resistance is associated with circulating fibrinogen levels in nondiabetic patients receiving peritoneal dialysis.
abstract: BACKGROUND
  Insulin resistance (IR) and inflammation are associated with increased risk of cardiovascular disease in the general population. Continuous glucose absorption in peritoneal dialysis (PD) may induce hyperglycemia and hyperinsulinemia.
  
  
  METHODS
  We evaluated IR in nondiabetic patients receiving PD, and analyzed the association between IR and systemic inflammation biomarkers by performing a cross-sectional study on ambulatory dialysis. A total of 25 nondiabetic patients receiving PD and 25 healthy individuals, matched for gender, age, and body mass index (BMI), were included. The PD group was composed of 11 men and 14 women, with a mean age of 47 +/- 14 years and mean BMI of 25.5 +/- 4.7 kg/m(2). The control group was composed of 10 men and 15 women, with a mean age of 45 +/- 12 years and BMI of 24.0 +/- 2.8 kg/m(2).
  
  
  RESULTS
  IR was evaluated by the homeostasis model assessment method (HOMA-IR). Inflammation was assessed through high-sensitivity C-reactive protein (CRP) and fibrinogen. Body composition and truncal fat were evaluated by dual energy x-ray absorptiometry. HOMA-IR was significantly higher (P < .0001) in subjects receiving PD (4.9, range: 2.3-9.3 mmol/L x muU/mL) compared with healthy subjects (1.2, range: 0.4-4.8 mmol/L x muU/mL). As expected, compared with controls, patients receiving PD had significantly higher levels of insulin (26.5 +/- 7.5 muU/mL vs 6.3 +/- 3.4 muU/mL; P < .0001), CRP (6.3, range: 0.3-61.1 mg/L vs 2.4, range: 0.6-5.9 mg/L; P = .001), and fibrinogen (379 +/- 101 mg/dL vs 268 +/- 66 mg/dL; P < .0001). However, there were no significant differences in body and truncal fat mass between the groups. A significant correlation between HOMA-IR and fibrinogen (Rho = 0.48; P = .01) was observed. However, no correlation was found between HOMA-IR and CRP. Also, no significant correlations were found between HOMA-IR and body fat mass (Rho = 0.11), and between HOMA-IR and truncal fat mass (Rho = 0.19).
  
  
  CONCLUSIONS
  Patients receiving PD demonstrate a state of IR that is associated with high circulating levels of fibrinogen. This suggests that hyperfibrinogenemia may be involved in the pathogenesis of IR in this setting.
authors.affiliation: Renal Diabetes and Hypertension Research Center, Pró-Renal Foundation of Curitiba, Curitiba, Brazil. crismar@onda.com.br <crismar@onda.com.br>
authors.forename: Cristina
authors.initials: C
authors.lastname: Martins
authors.forename: Marcelo
authors.initials: M
authors.lastname: Mazza do Nascimento
authors.forename: Roberto
authors.initials: R
authors.lastname: Pecoits-Filho
authors.forename: Cyntia
authors.initials: C
authors.lastname: Leinig
authors.forename: Luiz Felipe
authors.initials: LF
authors.lastname: Gonçalves
authors.forename: Roseana
authors.initials: R
authors.lastname: Fuerbringer
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Miguel Carlos
authors.initials: MC
authors.lastname: Riella
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein