Relation of low glomerular filtration rate to metabolic disorders in individuals without diabetes and with normoalbuminuria.
OBJECTIVE
Microalbuminuria increases cardiovascular risk and is considered a metabolic disorder. Low glomerular filtration rate is also associated with increased cardiovascular risk, but the relation of low glomerular filtration rate to metabolic disorders is not well understood.


METHODS
Designed as a cross-sectional, epidemiologic study, the Insulin Resistance Atherosclerosis Study was conducted in four centers: San Antonio (Texas), San Luis Valley (Colorado), and Oakland and Los Angeles (California). The Modification of Diet in Renal Disease equation was used to classify individuals without diabetes and with normoalbuminuria (n = 856; age 40 to 69 yr) by the presence or absence of low glomerular filtration rate (<60 ml/min per 1.73 m(2)). A direct marker of insulin resistance, the insulin sensitivity index, was measured by the frequently sampled intravenous glucose tolerance test.


RESULTS
Low glomerular filtration rate was related to hypertension and the metabolic syndrome. Low glomerular filtration rate was associated with fasting insulin concentration and insulin sensitivity index. Low glomerular filtration rate was also associated with insulin concentration after adjustment for potential determinants of glomerular filtration rate but was not associated with insulin sensitivity index.


CONCLUSIONS
Low glomerular filtration rate is associated with increased insulin concentration in individuals without diabetes and with normoalbuminuria. Longitudinal analyses are needed to determine whether insulin concentration (insulin resistance) precedes the deterioration of renal function.
Lorenzo
Carlos
C
Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7873, USA. lorenzo@uthscsa.edu
Nath
Subrata D
SD
Hanley
Anthony J G
AJ
Abboud
Hanna E
HE
Haffner
Steven M
SM
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000503:physiopathology; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology; D005215:Fasting / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D008875:Middle Aged; D015206:Southwestern United States / Q000453:epidemiology
D007328:Insulin; D020738:Leptin; D002097:C-Reactive Protein