[Insulin resistance and chronic kidney disease]

Insulin resistance is characterized by a lesser biological response to a standard level of insulin. Currently the most popular method used to quantify insulin resistance is the homeostasis model of assessment of insulin resistance (HOMA-IR). A state of insulin resistance is present from the early stages of chronic renal failure (CRF). Defects in glucose utilization observed during CRF concern both nonoxidative metabolism (storage in the form of glycogen) and oxidative metabolism. Resistance to the action of insulin during the CRF concerns traditionally peripheral tissues, particularly skeletal muscle. The mechanisms are multiple: retention of nitrogenous waste, metabolic acidosis, hypovitaminosis D or inflammation. The insulin resistance is associated with a disturbance of endothelial function and is involved in increased vascular risk and aggravates muscle metabolic disorders. Recent studies demonstrated a link between insulin resistance and progression of renal failure. Physical activity is known to improve insulin resistance status, the correction of metabolic abnormalities and attempts to reduce the inflammatory syndrome are potential targets of treatment. Thiazolidinedione have recently shown their interest, but in CRF the balance between risk and benefit remains to be evaluated.