Is there a link between insulin resistance and chronic kidney disease in men with treated hypertension? Analysis of 5-year data.
OBJECTIVE
Hypertension, chronic kidney disease (CKD) and cardiovascular disease (CVD) have reached epidemic proportions globally. Patients with CKD are at increased risk of CVD and yet conventional factors have yet to be linked with the risk associated with patients with CKD. The aim of this research was to establish whether there is a link between insulin resistance (IR) and estimated glomerular filtration rate (eGFR), and assess whether insulin-resistant subjects experience a more rapid deterioration in eGFR.


METHODS
IR was determined using HOMA-IR (homeostasis model assessment for IR) in normoglycaemic, male subjects with treated hypertension and correlated with clinical variables over a period of 5 years.


RESULTS
106 subjects were assigned to three groups according to insulin sensitivity. Patients with IR had a higher body mass index, fasting glucose, triglyceride and lower HDL cholesterol. Half of the insulin-resistant patients developed an impaired fasting glucose by 1 year and 14% were being treated for type 2 diabetes mellitus by 5 years. Baseline and 5-year data revealed that there was no link between IR and eGFR, which deteriorated equally in all groups.


CONCLUSIONS
We established that both CKD and IR are common and that the majority of subjects with IR developed impaired fasting glucose or type 2 diabetes mellitus in only 5 years. Although eGFR deteriorated in all groups, no link was found between eGFR and IR.
Mohteshamzadeh
Mobin
M
Royal Berkshire NHS Foundation Trust-Nephrology, Renal Unit, London Road, Reading, UK. mobin@doctors.org.uk
Wong
Christopher
C
Whiticar
Rebecca
R
Thomas
Simon
S
D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D018149:Glucose Intolerance / Q000453:epidemiology / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000378:metabolism*; D012307:Risk Factors
D000959:Antihypertensive Agents