title: Hyperinsulinemia and insulin resistance, early cardiovascular risk factors in children with chronic kidney disease.
abstract: OBJECTIVE
  Pediatric chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease. Still, hyperinsulinemia and insulin resistance, common cardiovascular risk factors, are not extensively investigated in children with CKD. We hypothesize that insulin abnormalities are present also in pediatric mild to moderate CKD, and associated with inflammation and malnutrition.
  
  
  METHODS
  We enrolled 26 children with CKD, and 34 healthy controls for analyses of blood samples and body composition. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR).
  
  
  RESULTS
  The patients had higher insulin levels and HOMA-IR compared to the controls (p < 0.01 and p < 0.005), and they correlated inversely with estimated glomerular filtration rate (rho = -0.52, p < 0.01; rho = -0.37, p = 0.08). No association was found with inflammation or malnutrition.
  
  
  CONCLUSIONS
  High insulin levels and HOMA-IR appear to be common in pediatric CKD patients, already in mild to moderate renal failure. We hypothesize that hyperinsulinemia and insulin resistance alone might be important risk factors for cardiovascular disease in children with CKD.
authors.affiliation: Division of Pediatrics, Intervention and Technology, Karolinska Institute and Karolinska University Hospital Huddinge, Stockholm, Sweden. ylva.tranaeus-lindblad@karolinska.se
authors.forename: Ylva Tranaeus
authors.initials: YT
authors.lastname: Lindblad
authors.forename: Jonas
authors.initials: J
authors.lastname: Axelsson
authors.forename: Peter
authors.initials: P
authors.lastname: Bárány
authors.forename: Gianni
authors.initials: G
authors.lastname: Celsi
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: Alba
authors.initials: A
authors.lastname: Carrea
authors.forename: Alberto
authors.initials: A
authors.lastname: Canepa
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000209:etiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005919:Glomerular Filtration Rate; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D007249:Inflammation; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000150:complications*; D044342:Malnutrition; D012307:Risk Factors