title: Insulin resistance and the metabolic syndrome are associated with arterial stiffness in patients with chronic kidney disease.
abstract: BACKGROUND
  Insulin resistance (IR) and the metabolic syndrome (MetS) may contribute to cardiovascular risk in chronic kidney disease (CKD). We examine the association between IR and vascular function in CKD. Furthermore, we define the prevalence of MetS and examine the association between defining MetS and vascular function.
  
  
  METHODS
  This cross-sectional study of 71 stage 3-4 CKD subjects assessed arterial stiffness (pulse wave velocity (PWV) and endothelial dysfunction (ED). IR was assessed using Homeostasis Model Assessment-IR (HOMA-IR). MetS was defined by the unified International Diabetes Federation and American Heart Association/National Heart Lung and Blood Institute criteria.
  
  
  RESULTS
  CKD subjects with HOMA-IR score above the median had significantly higher body mass index and waist circumference. They also had higher PWV, higher triglycerides with lower high-density lipoprotein concentration (P < 0.05). Age, systolic blood pressure, and HOMA-IR were independently associated with PWV, even after exclusion of diabetic subjects (n = 16) (P ≤ 0.05). MetS was more prevalent in CKD (78.9%) than controls (2.5%). MetS in CKD was associated with increased PWV (MetS(+) geometric mean = 9.5 m/s, 95% confidence interval (95% CI) = 8.9-10.2 m/s; vs. MetS(-) 8.1 m/s, 95% CI = 7.1-9.3 m/s; P = 0.03) but not ED. In a multiple logistic regression analysis, PWV higher than the median was independently associated with dysglycemia.
  
  
  CONCLUSIONS
  IR is independently associated with arterial stiffness, even in nondiabetic CKD. MetS is common and identified a subgroup of CKD patients with increased arterial stiffness, which is associated with dysglycemia.
authors.affiliation: School Of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Western Australia, Australia;
authors.forename: Doris T
authors.initials: DT
authors.lastname: Chan
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Watts
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Irish
authors.forename: Esther M M
authors.initials: EM
authors.lastname: Ooi
authors.forename: Gursharan K
authors.initials: GK
authors.lastname: Dogra
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000150:complications / Q000453:epidemiology; D005260:Female; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D008954:Models, Biological; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D014652:Vascular Diseases / Q000150:complications / Q000453:epidemiology; D059289:Vascular Stiffness; D055105:Waist Circumference
keywords: blood pressure; chronic kidney disease; hypertension; insulin resistance; metabolic syndrome; vascular function.