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Effects of insulin resistance on left ventricular hypertrophy in patients with CKD stage 1-3
Cheng-jun Wang1, Xiao-rong Bao, Guo-wei Du
1Department of Nephrology, Jinshan Hospital, Fudan University, Long Route 1508, Jinshan, Shanghai, 201508, China.
Insights
Insulin resistance (IR) and left ventricular hypertrophy (LVH) are common in early chronic kidney disease (CKD). These conditions are linked and worsen with CKD progression, alongside factors like reduced e-GFR and anemia.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Left ventricular hypertrophy (LVH) is prevalent in early chronic kidney disease (CKD).
- The presence and relationship of insulin resistance (IR) with LVH in early CKD remain unclear.
Purpose of the Study:
- To investigate the existence and prevalence of IR in early-stage CKD patients.
- To determine the relationship between IR, LVH, and other clinical parameters in early CKD.
Main Methods:
- Homeostasis model assessment of insulin resistance (HOMA-IR) was used to measure IR in 336 subjects (286 early CKD patients, 50 controls).
- Clinical data, including HOMA-IR, were collected and analyzed for correlations with LVH and other variables.
Main Results:
- IR and LVH were present in early CKD patients, with higher prevalence of LVH in IR patients and vice versa.
- Patients with IR or LVH exhibited lower e-GFR and hemoglobin, and higher BUN, serum creatinine, iPTH, CRP, and SBP.
- HOMA-IR and LVMI positively correlated with BUN, Scr, iPTH, CRP, and negatively with e-GFR and Hb. CKD and IR were identified as main risk factors for LVH.
Conclusions:
- IR and LVH are present and associated in early CKD, worsening as CKD progresses.
- Declining e-GFR, hypertension, and anemia are linked to both IR and LVH, potentially mediating IR's effect on LVH development.
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).
Conclusion:
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.
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