. 2019 Feb 20;20(1):60.

doi: 10.1186/s12882-019-1220-6.

Insulin resistance and chronic kidney disease progression, cardiovascular events, and death: findings from the chronic renal insufficiency cohort study

Sarah J Schrauben^{1

2}, Christopher Jepson^{3

4}, Jesse Y Hsu^{3

4}, F Perry Wilson⁵, Xiaoming Zhang^{3

4}, James P Lash⁶, Bruce M Robinson⁷, Raymond R Townsend⁸, Jing Chen⁹, Leon Fogelfeld¹⁰, Patricia Kao¹¹, J Richard Landis^{3

4}, Daniel J Rader⁸, L Lee Hamm⁹, Amanda H Anderson^{4

12}, Harold I Feldman^{8

3

4}

Affiliations

¹ Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA. Sarah.Schrauben@uphs.upenn.edu.
² Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA. Sarah.Schrauben@uphs.upenn.edu.
³ Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.
⁴ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁵ Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
⁶ Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
⁷ Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
⁸ Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA.
⁹ Department of Medicine, Tulane University School of Medicine, New Orleans, Lousiana, USA.
¹⁰ Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
¹¹ Deparment of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA.
¹² Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.

PMID: 30786864
PMCID: PMC6383235
DOI: 10.1186/s12882-019-1220-6

Insulin resistance and chronic kidney disease progression, cardiovascular events, and death: findings from the chronic renal insufficiency cohort study

Sarah J Schrauben et al. BMC Nephrol. 2019.

. 2019 Feb 20;20(1):60.

doi: 10.1186/s12882-019-1220-6.

Authors

Affiliations

¹ Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA. Sarah.Schrauben@uphs.upenn.edu.
² Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA. Sarah.Schrauben@uphs.upenn.edu.
³ Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.
⁴ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁵ Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
⁶ Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
⁷ Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
⁸ Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA.
⁹ Department of Medicine, Tulane University School of Medicine, New Orleans, Lousiana, USA.
¹⁰ Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
¹¹ Deparment of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA.
¹² Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.

PMID: 30786864
PMCID: PMC6383235
DOI: 10.1186/s12882-019-1220-6

Abstract

Background: Insulin resistance contributes to the metabolic syndrome, which is associated with the development of kidney disease. However, it is unclear if insulin resistance independently contributes to an increased risk of chronic kidney disease (CKD) progression or CKD complications. Additionally, predisposing factors responsible for insulin resistance in the absence of diabetes in CKD are not well described. This study aimed to describe factors associated with insulin resistance and characterize the relationship of insulin resistance to CKD progression, cardiovascular events and death among a cohort of non-diabetics with CKD.

Methods: Data was utilized from Chronic Renal Insufficiency Cohort Study participants without diabetes (N = 1883). Linear regression was used to assess associations with insulin resistance, defined using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The relationship of HOMA-IR, fasting glucose, hemoglobin A1c (HbA1c), and C-peptide with CKD progression, cardiovascular events, and all-cause mortality was examined with Cox proportional hazards models.

Results: Novel positive associations with HOMA-IR included serum albumin, uric acid, and hemoglobin A1c. After adjustment, HOMA-IR was not associated with CKD progression, cardiovascular events, or all-cause mortality. There was a notable positive association of one standard deviation increase in HbA1c with the cardiovascular endpoint (HR 1.16, 95% CI: 1.00-1.34).

Conclusion: We describe potential determinants of HOMA-IR among a cohort of non-diabetics with mild-moderate CKD. HOMA-IR was not associated with renal or cardiovascular events, or all-cause mortality, which adds to the growing literature describing an inconsistent relationship of insulin resistance with CKD-related outcomes.

Keywords: Cardiovascular disease; Chronic kidney disease; Chronic renal insufficiency; Insulin resistance; Mortality.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by: University of Pennsylvania Institutional Review Board (Federalwide Assurance # 00004028), Johns Hopkins Institutional Review Board (Study # NA_00044034/CIR00004697), The University of Maryland, Baltimore Institutional Review Board, University Hospitals Cleveland Medical Center Institutional Review Board, MetroHealth Institutional Review Board, Cleveland Clinic Foundation Institutional Review Board (IRB #5969), University of Michigan Medical School Institutional Review Board (IRBMED), Wayne State University Institutional Review Board,

University of Illinois at Chicago Institutional Review Board, Tulane Human Research Protection Office, Institutional Review Boards, Biomedical Social Behavioral (reference#: 140987), and Kaiser Permanente Northern California Institutional Review Board. The study is in accordance with the Declaration of Helsinki. All participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

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Insulin resistance and chronic kidney disease progression, cardiovascular events, and death: findings from the chronic renal insufficiency cohort study

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Insulin resistance and chronic kidney disease progression, cardiovascular events, and death: findings from the chronic renal insufficiency cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

References

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