title: Measurement of insulin resistance in chronic kidney disease.
abstract: OBJECTIVE
  Insulin resistance is a known complication of end-stage renal disease that also appears to be present in earlier stages of chronic kidney disease (CKD). It is a risk factor for cardiovascular disease and an important potential therapeutic target in this population. Measurement of insulin resistance is reviewed in the context of known pathophysiologic abnormalities in CKD.
  
  
  RESULTS
  Insulin resistance in CKD is due to a high prevalence of known risk factors (e.g. obesity) and to unique metabolic abnormalities. The site of insulin resistance in CKD is localized to skeletal muscle. Estimates based on fasting insulin concentration may not adequately capture insulin resistance in CKD because they largely reflect hepatic defects and because CKD impairs insulin catabolism. A variety of dynamic tests are available to directly measure insulin-mediated glucose uptake.
  
  
  CONCLUSIONS
  Insulin resistance may be an important therapeutic target in CKD. Complementary methods are available to assess insulin resistance, and each method has unique advantages, disadvantages, and levels of complexity. These characteristics, and the likelihood that CKD alters the performance of some insulin resistance measurements, must be considered when designing and interpreting clinical studies.
authors: Division of Nephrology and Kidney Research Institute, Department of Medicine, Seattle VA Puget Sound Healthcare System, Washington, USA.
authors: Hien
authors: H
authors: Pham
authors: Kristina M
authors: KM
authors: Utzschneider
authors: Ian H
authors: IH
authors: de Boer
mesh_terms: D002318:Cardiovascular Diseases / Q000532:radiotherapy; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism*