Effects of insulin resistance on left ventricular hypertrophy in patients with CKD stage 1-3.
BACKGROUND
Left ventricular hypertrophy (LVH) existed in patients with early stage chronic kidney disease (CKD). But whether insulin resistance (IR) exists in these patients and has some definite relationship with LVH, is unknown.


METHODS
Homeostatic model method was used for detecting homeostasis model assessment of insulin resistance (HOMA-IR) in 336 subjects including 286 patients with early stage CKD and 50 control subjects, and HOMA-IR and other clinical data in all subjects were obtained based on standard methods. Then, the relationship between LVH, IR and other relevant clinical data were analyzed.


RESULTS
IR and LVH existed in early stage CKD patients. The prevalence of LVH in patients with IR was significantly higher than those without, and patients with LVH had a higher prevalence of IR than those without. The patients with IR or LVH had lower levels of e-GFR, hemoglobin (Hb) and total cholesterol, while higher levels of blood urea nitrogen (BUN), serum creatinine (Scr), intact parathyroid hormone (iPTH), CRP and systolic blood pressure (SBP). HOMA-IR had positive correlations with left ventricular mass index (LVMI). HOMA-IR and LVMI had positive correlations with BUN, Scr, iPTH and CRP, but negative with e-GFR and Hb. Multiple linear stepwise regression analysis showed that e-GFR, FINS, Hb and SBP enter the regression equation. Binary unconditional logistic regression analysis indicated that the main risk factors for LVH were CKD and IR (P < 0.05, respectively).


CONCLUSIONS
Both IR and LVH existed in early stage CKD patients and were more severe with the development of CKD. IR had a significant correlation with LVH. Furthermore, decline of e-GFR, hypertension and anemia were also associated with both IR and LVH and may have some effects in the mechanism of IR on the development of LVH.
Department of Nephrology, Jinshan Hospital, Fudan University, Long Route 1508, Jinshan, Shanghai, 201508, China.
Cheng-jun
CJ
Wang
Xiao-rong
XR
Bao
Guo-wei
GW
Du
Yu
Y
Wang
Kai
K
Chen
Ma-li
ML
Shen
Li-zhen
LZ
Wang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003404:Creatinine / Q000097:blood / Q000652:urine; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood; D055815:Young Adult
D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006454:Hemoglobins; D007328:Insulin; D010281:Parathyroid Hormone; D010710:Phosphates; D014280:Triglycerides; D014527:Uric Acid; D002097:C-Reactive Protein; D003404:Creatinine; D002118:Calcium