title: Insulin resistance as a predictor of cardiovascular disease in patients on peritoneal dialysis.
abstract: BACKGROUND
  Insulin resistance is associated with multiple risk factors for cardiovascular (CV) disease in the general population. Patients on peritoneal dialysis (PD) are more likely to develop insulin resistance. However, no evaluation of the impact of insulin resistance on CV disease morbidity or mortality in patients on PD has been performed.
  
  
  METHODS
  Our prospective cohort study included all non-diabetic patients on PD at our center (n = 66). Insulin resistance was evaluated at baseline by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels. The cohort was followed for up to 58 months (median: 41.3 months; interquartile range: 34.3 months). A multivariate Cox model was used to analyze the impact of insulin resistance on CV disease mortality.
  
  
  RESULTS
  Fourteen CV events occurred in the higher HOMA-IR group [IR-H (HOMA-IR values in the range 2.85 - 19.5), n = 33], but only one event occurred in the lower HOMA-IR group (IR-L (HOMA-IR values in the range 0.83 - 2.71), n = 33) during the follow-up period. Level of HOMA-IR was a significant predictor of CV events [risk ratio: 17.7; 95% confidence interval (CI): 2.10 to 149.5; p = 0.008]. In the IR-H group, 10 patients died (8 CV events), but in the IR-L group, only 4 patients died (1 CV event). Patients in the IR-H group experienced significantly higher CV mortality (hazard ratio: 9.02; 95% CI: 1.13 to 72.2; p = 0.04). Even after adjustments for age, systolic blood pressure, body mass index, C-reactive protein, triglycerides, resistin, and leptin, HOMA-IR remained an independent predictor of CV mortality (hazard ratio: 14.8; 95% CI: 1.22 to 179.1; p = 0.03).
  
  
  CONCLUSIONS
  Insulin resistance assessed using HOMA-IR was an independent predictor of CV morbidity and mortality in a cohort of nondiabetic patients on PD. Insulin resistance is a modifiable risk factor; the reduction of insulin resistance may reduce CV risk and improve survival in this group of patients.
authors: Department of Nephrology, Huashan Hospital of Fudan University, Shanghai, PR China.
authors: Yun
authors: Y
authors: Li
authors: Lihua
authors: L
authors: Zhang
authors: Yong
authors: Y
authors: Gu
authors: Chuanming
authors: C
authors: Hao
authors: Tongying
authors: T
authors: Zhu
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors
keywords: Cardiovascular mortality; cardiovascular morbidity; chronic kidney disease; homeostatic model assessment; insulin resistance