Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Dec 2;13(12):4349.
doi: 10.3390/nu13124349.

Role and Treatment of Insulin Resistance in Patients with Chronic Kidney Disease: A Review

Akio Nakashima  1 , Kazuhiko Kato  1 , Ichiro Ohkido  1 , Takashi Yokoo  1
Affiliations
Review

Role and Treatment of Insulin Resistance in Patients with Chronic Kidney Disease: A Review

Akio Nakashima et al. Nutrients. .

Abstract

Patients with chronic kidney disease (CKD) and dialysis have higher mortality than those without, and cardiovascular disease (CVD) is the main cause of death. As CVD is caused by several mechanisms, insulin resistance plays an important role in CVD. This review summarizes the importance and mechanism of insulin resistance in CKD and discusses the current evidence regarding insulin resistance in patients with CKD and dialysis. Insulin resistance has been reported to influence endothelial dysfunction, plaque formation, hypertension, and dyslipidemia. A recent study also reported an association between insulin resistance and cognitive dysfunction, non-alcoholic fatty liver disease, polycystic ovary syndrome, and malignancy. Insulin resistance increases as renal function decrease in patients with CKD and dialysis. Several mechanisms increase insulin resistance in patients with CKD, such as chronic inflammation, oxidative stress, obesity, and mineral bone disorder. There is the possibility that insulin resistance is the potential future target of treatment in patients with CKD.

Keywords: cardiovascular disease; chronic kidney disease; insulin resistance; vitamin D.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflict of interest.

Figures

Figure 1
Figure 1
Insulin resistance and chronic kidney disease: RAAS, renin–angiotensin–aldosterone sys; FGF-23, fibroblast growth factor 23; NAFLD, non-alcoholic fatty liver disease; FFA, free fatty acid. In this figure, up-arrow shows enhanced activity and down-arrow shows reduced activity.
Figure 2
Figure 2
CKD-MBD and insulin resistance: CKD, chronic kidney disease; MBD, mineral bone disorder; FGF23 fibroblast growth factor 23; PTH, parathyroid hormone; 25OHD, 25 hydroxyvitamin D; 1,25(OH)2D, 1,25 dihydroxy vitamin D; VDR, vitamin D receptor. In this figure, up-arrow shows enhanced activity and down-arrow shows reduced activity.
See this image and copyright information in PMC

References

    1. Czech M.P. Insulin action and resistance in obesity and type 2 diabetes. Nat. Med. 2017;23:804–814. doi: 10.1038/nm.4350. - DOI - PMC - PubMed
    1. Welsh P., Preiss D., Lloyd S.M., De Craen A.J., Jukema J.W., Westendorp R.G., Buckley B.M., Kearney P., Briggs A., Stott D.J., et al. Contrasting associations of insulin resistance with diabetes, cardiovascular disease and all-cause mortality in the elderly: PROSPER long-term follow-up. Diabetologia. 2014;57:2513–2520. doi: 10.1007/s00125-014-3383-9. - DOI - PubMed
    1. de Boer I.H., Katz R., Chonchol M.B., Fried L.F., Ix J.H., Kestenbaum B., Mukamal K.J., Peralta C.A., Siscovick D.S. Insulin Resistance, Cystatin C, and Mortality Among Older Adults. Diabetes Care. 2012;35:1355–1360. doi: 10.2337/dc11-1657. - DOI - PMC - PubMed
    1. Xu H., Carrero J.J. Insulin resistance in chronic kidney disease. Nephrology. 2017;22:31–34. doi: 10.1111/nep.13147. - DOI - PubMed
    1. Hanks L.J., Casazza K., Judd S.E., Jenny N.S., Gutiérrez O.M. Associations of Fibroblast Growth Factor-23 with Markers of Inflammation, Insulin Resistance and Obesity in Adults. PLoS ONE. 2015;10:e0122885. doi: 10.1371/journal.pone.0122885. - DOI - PMC - PubMed

MeSH terms