Related Experiment Video
Updated: Apr 10, 2026
Study of In Vivo Glucose Metabolism in High-fat Diet-fed Mice Using Oral Glucose Tolerance Test OGTT and Insulin Tolerance Test ITT
Published on: January 7, 2018
Insulin resistance as a predictor of cardiovascular morbidity and end-stage renal disease
André Fragoso1, Filipa Mendes1, Ana Paula Silva2
1Nephrology Department, Centro Hospitalar do Algarve, Faro, Portugal.
Insights
Insulin resistance (IR) predicts cardiovascular disease and end-stage renal disease (ESRD) in patients with type 2 diabetes and chronic kidney disease (CKD). Higher IR levels correlate with increased cardiovascular events and faster CKD progression.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Cardiovascular disease (CVD) is a leading cause of death in chronic kidney disease (CKD) patients.
- Insulin resistance (IR) is a known risk factor for CVD.
- Predicting CVD and end-stage renal disease (ESRD) in diabetic CKD patients is crucial.
Purpose of the Study:
- To evaluate insulin resistance (IR) as a predictor of cardiovascular morbidity.
- To assess the role of IR in the progression to end-stage renal disease (ESRD).
Main Methods:
- A 56-month follow-up study of 119 type 2 diabetic CKD patients (stages 2-4) without prior CVD.
- Insulin resistance (IR) estimated using Homeostasis Model Assessment (HOMA-IR).
- Cardiovascular morbidity assessed by hospital admissions; renal survival by Kaplan-Meier analysis.
Main Results:
- Higher HOMA-IR levels were significantly associated with increased cardiovascular morbidity and ESRD.
- HOMA-IR and IL-6 were independent risk factors for cardiovascular morbidity.
- Elevated HOMA-IR predicted a higher progression rate to ESRD and reduced renal survival.
Conclusions:
- Insulin resistance (IR) is a significant predictor of cardiovascular morbidity in diabetic CKD patients.
- IR is also an independent risk factor for the progression to ESRD in this population.
Background:
Cardiovascular disease (CVD) is the main risk factor of morbidity and mortality in chronic kidney disease (CKD) patients. Insulin resistance (IR) has been reported to be a strong risk factor for CVD. The purpose of this study was to examine the usefulness of IR as a predictor of cardiovascular morbidity and end-stage renal disease (ESRD).
Methods:
We followed during a period of 56months 119 type 2 diabetic CKD patients (stages 2 to 4) without history of CVD at the beginning of the study. Several laboratory parameters and left ventricular mass index (LVMI) were analyzed. The degree of IR was estimated by the Homeostasis Model Assessment (HOMA-IR). Cardiovascular morbidity was assessed according to the presence of cardiovascular hospital admission during the study period, defined by admissions caused by coronary heart disease, congestive heart failure, peripheral vascular disease and cerebrovascular disease. The population was divided in two groups: G-1 with cardiovascular admission (n=48) and G-2: without admission (n=71). The multiple logistic regression was used to assess predictors of cardiovascular morbidity and ESRD. The renal survival was evaluated by the Kaplan-Meier and long-rank test.
Results:
We found that G-1 patients showed significantly higher HOMA-IR (3.8 vs 0.77, p=0.0001) and that HOMA-IR upper tercile showed significantly higher age, eGFR, LVMI, phosphorus, iPTH and IL-6. In a multivariate logistic regression model HOMA-IR and IL-6 were independent risk factors of cardiovascular morbidity (OR=2.847 [95% CI 1.048-7.735, p=0.012] and OR=2.483 [95% CI 1.221-5.049, p=0.04], respectively). In a univariate logistic regression model patients in the upper tercile presented significantly more cardiovascular admissions that in the lower tercile. CKD progression to ESRD was observed in 24 patients and those in the upper HOMA-IR tercile showed a higher CKD progression to ESRD than the rest of study patients. A multivariate logistic regression model showed that HOMA-IR (OR=1.034, 95% CI (1.005-1.650) p=0.040) was an independent predictor of ESRD. Kaplan-Meier analysis showed a difference in renal survival in the HOMA-IR terciles (log rank=8.093; p=0.017).
Conclusion:
In our study IR is an important risk factor for cardiovascular morbidity and ESRD in a diabetic CKD population.
More Related Videos
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:25Chronic Kidney Disease I: Introduction
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:22Diabetes Mellitus: Type 2 and Gestational
01:36Carbohydrate Metabolism
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
01:22Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...