1
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Lin CA, Liu YP, Chen YC, Yu W, Xiong XJ, Huang HY, Li WC, Chen JY. Gender-specific and age-specific associations of the homoeostasis model assessment for IR (HOMA-IR) with albuminuria and renal function impairment: a retrospective cross-sectional study in Southeast China. BMJ Open 2021; 11:e053649. [PMID: 34921082 PMCID: PMC8685940 DOI: 10.1136/bmjopen-2021-053649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The study aimed to investigate the association of insulin resistance (IR), which was estimated by the homoeostasis model assessment for IR (HOMA-IR), with albuminuria and renal function impairment in a general Chinese population. DESIGN A retrospective cross-sectional study. SETTING AND PARTICIPANTS A total of 13 742 adults (age: ≥18 years) who underwent a health check-up at a hospital in Southeast China during 2013-2014 were enrolled. 216 subjects were excluded due to lack of enough fasting time, be pregnant, have chronic diseases influencing metabolic functions or have glomerulonephritis, renal cancer, kidney transplant. Eventually, 7552 men and 5974 women were included for the present analysis. PRIMARY OUTCOME MEASURES The association of HOMA-IR with albuminuria and renal function impairment were analysed. The HOMA-IR cut-off value for detecting albuminuria and renal function impairment were determined. RESULTS An increase in the HOMA-IR quartile was significantly associated with the prevalence of albuminuria and renal function impairment in all men and women aged >45 years. The multivariable logistic regression analyses revealed a significant association of the HOMA-IR with albuminuria and renal function impairment in subjects aged >45 years of the fourth quartiles compared with those of the first quartile after adjusting for potential confounders (albuminuria: men OR, 2.39; 95% CI 1.51 to 3.79, p<0.001; women OR, 2.40; 95% CI 1.44 to 4.01; p=0.001; renal function impairment: men OR, 2.30; 95% CI 1.50 to 3.51; p<0.001; women OR, 2.20; 95% CI 1.35 to 3.58; p=0.002). The optimal cut-off value of HOMA-IR for detecting albuminuria and renal function impairment was 2.69 in men aged ≤45 years, 1.60 in men aged >45 years and 1.86 in women aged >45 years. CONCLUSIONS Our study revealed that HOMA-IR was significantly associated with albuminuria and renal function impairment in individuals aged >45 years.
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Affiliation(s)
- Chieh-An Lin
- Department of Family Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Yu-Ping Liu
- Department of Endocrinology and Metabolism, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Yi-Chuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei Yu
- Department of Health Management, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Xue-Jie Xiong
- Department of Oncology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Hsiung-Ying Huang
- Department of Pulmonary and Critical Care Medicine, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Wen-Cheng Li
- Department of Family Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Health Management, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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2
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Akwo EA, Sahinoz M, Alsouqi A, Siew ED, Ikizler TA, Hung AM. Effect Modification of Body Mass Index and Kidney Function on Insulin Sensitivity Among Patients With Moderate CKD and Healthy Controls. Kidney Int Rep 2021; 6:2811-2820. [PMID: 34805633 PMCID: PMC8589704 DOI: 10.1016/j.ekir.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Insulin resistance and obesity are prevalent in chronic kidney disease (CKD) patients. The interaction of body mass index (BMI) and kidney function across the continuum of estimated glomerular filtration rate (eGFR) is unknown. Methods In a cross-sectional study of 139 patients, 52 with CKD stages 3 and 4 and 87 patients with normal eGFR, we measured the insulin sensitivity index (ISI) using the hyperinsulinemic euglycemic clamp and homeostasis model assessment of insulin resistance (HOMA-IR). We investigated the interaction between eGFR and BMI in their association with ISI and HOMA-IR using linear models with robust standard errors. Results Median age was 56 (42, 66) years, 50.4% were female, and 36% were African American. Patients with low eGFR (∼30 ml/min per 1.73 m2) had low ISI (2.3 mg/min per μU/ml) regardless of BMI. Among patients with preserved eGFR (>90 ml/min per 1.73m2), BMI had a greater effect on ISI (6.3 mg/min per μU/ml at a BMI of 20 kg/m2 vs. 4.6 mg/min per μU/ml at a BMI of 30 kg/m2) (P for interaction = 0.046). In models adjusted for demographics, and log transformed interleukin-6, high-sensitivity C-reactive protein, leptin, and adiponectin, a 1-SD (28 ml/min per 1.73 m2) lower eGFR was associated with a statistically significant 1.14-unit decrease in ISI (95% confidence interval = −1.80, −0.48) among nonobese patients. Among obese patients, the effect estimate was −0.25 (95% confidence interval = −0.88, 0.39). The association between BMI and HOMA-IR was stronger in patients with lower eGFR (P for interaction = 0.005). Conclusion Both eGFR and BMI are independently associated with insulin sensitivity, but the strength of the association between BMI and insulin sensitivity varies significantly across eGFR.
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Affiliation(s)
- Elvis A Akwo
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA.,Tennessee Valley Healthcare System, Nashville VA Medical Center, Nashville, Tennessee, USA
| | - Melis Sahinoz
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aseel Alsouqi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA.,Tennessee Valley Healthcare System, Nashville VA Medical Center, Nashville, Tennessee, USA
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA.,Tennessee Valley Healthcare System, Nashville VA Medical Center, Nashville, Tennessee, USA
| | - Adriana M Hung
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA.,Tennessee Valley Healthcare System, Nashville VA Medical Center, Nashville, Tennessee, USA.,Vanderbilt Precision Nephrology Program, Nashville, Tennessee, USA
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3
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Garikapati K, Goh D, Khanna S, Echampati K. Uraemic Cardiomyopathy: A Review of Current Literature. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2021; 15:1179546821998347. [PMID: 33707979 PMCID: PMC7907931 DOI: 10.1177/1179546821998347] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/03/2021] [Indexed: 12/18/2022]
Abstract
Uraemic Cardiomyopathy (UC) is recognised as an intricate and multifactorial disease which portends a significant burden in patients with End-Stage Renal Disease (ESRD). The cardiovascular morbidity and mortality associated with UC is significant and can be associated with the development of arrythmias, cardiac failure and sudden cardiac death (SCD). The pathophysiology of UC involves a complex interplay of traditional implicative factors such as haemodynamic overload and circulating uraemic toxins as well as our evolving understanding of the Chronic Kidney Disease-Mineral Bone Disease pathway. There is an instrumental role for multi-modality imaging in the diagnostic process; including transthoracic echocardiography and cardiac magnetic resonance imaging in identifying the hallmarks of left ventricular hypertrophy and myocardial fibrosis that characterise UC. The appropriate utilisation of the aforementioned diagnostics in the ESRD population may help guide therapeutic approaches, such as pharmacotherapy including beta-blockers and aldosterone-antagonists as well as haemodialysis and renal transplantation. Despite this, there remains limitations in effective therapeutic interventions for UC and ongoing research on a cellular level is vital in establishing further therapies.
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Affiliation(s)
- Kartheek Garikapati
- Department of Internal Medicine,
Toowoomba Hospital, Toowoomba, QLD, Australia
| | - Daniel Goh
- Department of Internal Medicine,
Toowoomba Hospital, Toowoomba, QLD, Australia
- University of New South Wales, Sydney,
NSW, Australia
| | - Shaun Khanna
- Department of Internal Medicine,
Toowoomba Hospital, Toowoomba, QLD, Australia
- University of New South Wales, Sydney,
NSW, Australia
| | - Krishna Echampati
- Department of Internal Medicine,
Toowoomba Hospital, Toowoomba, QLD, Australia
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4
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Talenezhad N, Mohammadi M, Ramezani-Jolfaie N, Mozaffari-Khosravi H, Salehi-Abargouei A. Effects of l-carnitine supplementation on weight loss and body composition: A systematic review and meta-analysis of 37 randomized controlled clinical trials with dose-response analysis. Clin Nutr ESPEN 2020; 37:9-23. [DOI: 10.1016/j.clnesp.2020.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/31/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
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5
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Rahhal MN, Gharaibeh NE, Rahimi L, Ismail-Beigi F. Disturbances in Insulin-Glucose Metabolism in Patients With Advanced Renal Disease With and Without Diabetes. J Clin Endocrinol Metab 2019; 104:4949-4966. [PMID: 31162534 DOI: 10.1210/jc.2019-00286] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/29/2019] [Indexed: 02/03/2023]
Abstract
CONTEXT Use of insulin in patients with diabetes and advanced chronic kidney disease (CKD; stages 4 to 5) is challenging and shows great variability among individuals. We explored the mechanisms underlying this variability. EVIDENCE ACQUISITION PubMed was searched for articles in English from 1960 to 2018 for advanced CKD and diabetes, glucose and insulin metabolism, insulin clearance, secretion and resistance, plasma insulin concentration, glycemic control, hypoglycemia, insulin dosage, and continuous glucose monitoring (CGM) in CKD. EVIDENCE SYNTHESIS The evidence shows that in most patients the daily dose of insulin needs to be significantly reduced with a high degree of variability; in some the dose remains unchanged, and rarely it is increased. The premise that the marked reduction in insulin requirement is essentially attributable to decreased insulin clearance by kidneys leading to prolongation of its plasma half-life, elevated blood insulin concentration, and hypoglycemia is not entirely correct. Other factors including decreases in food intake, insulin secretion, insulin clearance by peripheral tissues, and renal gluconeogenesis play important roles. There is also heightened resistance to insulin due to metabolic acidosis, uremic toxins, inflammatory state, and vitamin D deficiency. Importantly, the magnitude of changes in each of these factors varies between individuals with the same degree of CKD. CONCLUSIONS In the presence of diabetes with advanced CKD, the insulin regimen should be individualized based on knowledge of the daily glucose patterns. The use of CGM is promising for safer glycemic control in patients with advanced CKD and diabetes and helps prevent extremes of hypoglycemia and hyperglycemia.
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Affiliation(s)
- Marie-Noel Rahhal
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Naser Eddin Gharaibeh
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leili Rahimi
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Faramarz Ismail-Beigi
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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6
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Fathizadeh H, Milajerdi A, Reiner Ž, Kolahdooz F, Asemi Z. The effects of L-carnitine supplementation on glycemic control: a systematic review and meta-analysis of randomized controlled trials. EXCLI JOURNAL 2019; 18:631-643. [PMID: 31611746 PMCID: PMC6785772 DOI: 10.17179/excli2019-1447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/03/2019] [Indexed: 12/12/2022]
Abstract
The findings of trials investigating the effect of L-carnitine administration on glycemic control are controversial. This meta-analysis of randomized controlled trials (RCTs) was performed to explore the effects of L-carnitine intake on glycemic control. Two authors independently searched electronic databases including MEDLINE, EMBASE, Cochrane Library, Web of Science, PubMed and Google scholar from 1990 until February 2019, in order to find relevant RCTs. 37 studies with 44 effect sizes met the inclusion criteria and were eligible for the meta-analysis. L-carnitine supplementation resulted in a significant reduction in fasting plasma glucose (FPG) (WMD: -4.57; 95 % CI: -6.88, -2.25), insulin (WMD: -1.21; 95 % CI: -1.85, -0.57), homeostatic model assessment for insulin resistance (HOMA-IR) (WMD: -0.67; 95 % CI: -0.90, -0.44) and HbA1C concentrations (WMD: -0.30; 95 % CI: -0.47, -0.13). L-Carnitine supplementation significantly reduced FPG, insulin, HOMA-IR, and HbA1c levels.
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Affiliation(s)
- Hadis Fathizadeh
- Department of Microbiology, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Milajerdi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Fariba Kolahdooz
- Indigenous and Global Health Research, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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7
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Schrauben SJ, Jepson C, Hsu JY, Wilson FP, Zhang X, Lash JP, Robinson BM, Townsend RR, Chen J, Fogelfeld L, Kao P, Landis JR, Rader DJ, Hamm LL, Anderson AH, Feldman HI. Insulin resistance and chronic kidney disease progression, cardiovascular events, and death: findings from the chronic renal insufficiency cohort study. BMC Nephrol 2019; 20:60. [PMID: 30786864 PMCID: PMC6383235 DOI: 10.1186/s12882-019-1220-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022] Open
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.
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Affiliation(s)
- Sarah J Schrauben
- Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.
| | - Christopher Jepson
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse Y Hsu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - F Perry Wilson
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Bruce M Robinson
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Raymond R Townsend
- Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA
| | - Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, Lousiana, USA
| | - Leon Fogelfeld
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Patricia Kao
- Deparment of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - J Richard Landis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Rader
- Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA
| | - L Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, Lousiana, USA
| | - Amanda H Anderson
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Harold I Feldman
- Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, 19103, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19103, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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8
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Giardino I, D'Apolito M, Brownlee M, Maffione AB, Colia AL, Sacco M, Ferrara P, Pettoello-Mantovani M. Vascular toxicity of urea, a new "old player" in the pathogenesis of chronic renal failure induced cardiovascular diseases. Turk Arch Pediatr 2017; 52:187-193. [PMID: 29483797 DOI: 10.5152/turkpediatriars.2017.6314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/03/2017] [Indexed: 12/30/2022]
Abstract
Chronic kidney disease in children is an irreversible process that may lead to end-stage renal disease. The mortality rate in children with end-stage renal disease who receive dialysis increased dramatically in the last decade, and it is significantly higher compared with the general pediatric population. Furthermore, dialysis and transplant patients, who have developed end-stage renal disease during childhood, live respectively far less as compared with age/race-matched populations. Different reports show that cardiovascular disease is the leading cause of death in children with end-stage renal disease and in adults with childhood-onset chronic kidney disease, and that children with chronic kidney disease are in the highest risk group for the development of cardiovascular disease. Urea, which is generated in the liver during catabolism of amino acids and other nitrogenous metabolites, is normally excreted into the urine by the kidneys as rapidly as it is produced. When renal function is impaired, increasing concentrations of blood urea will steadily accumulate. For a long time, urea has been considered to have negligible toxicity. However, the finding that plasma urea is the only significant predictor of aortic plaque area fraction in an animal model of chronic renal failure -accelerated atherosclerosis, suggests that the high levels of urea found in chronic dialysis patients might play an important role in accelerated atherosclerosis in this group of patients. The aim of this review was to provide novel insights into the role played by urea in the pathogenesis of accelerated cardiovascular disease in renal failure.
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Affiliation(s)
- Ida Giardino
- Research Center of Laboratory Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria D'Apolito
- Department of Pediatrics. Scientific Institute "Casa Sollievo della Sofferenza", University of Foggia, Italy
| | - Michael Brownlee
- Diabetes Research Center and Departments of Internal Medicine and Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angela Bruna Maffione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Anna Laura Colia
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Sacco
- Department of Pediatrics. Scientific Institute "Casa Sollievo della Sofferenza", University of Foggia, Italy
| | - Pietro Ferrara
- Campus Bio-Medico University Medical School, Rome, Italy
| | - Massimo Pettoello-Mantovani
- Department of Pediatrics. Scientific Institute "Casa Sollievo della Sofferenza", University of Foggia, Italy.,European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany
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9
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Deger SM, Hung AM, Gamboa JL, Siew ED, Ellis CD, Booker C, Sha F, Li H, Bian A, Stewart TG, Zent R, Mitch WE, Abumrad NN, Ikizler TA. Systemic inflammation is associated with exaggerated skeletal muscle protein catabolism in maintenance hemodialysis patients. JCI Insight 2017; 2:95185. [PMID: 29202452 DOI: 10.1172/jci.insight.95185] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Systemic inflammation and muscle wasting are highly prevalent and coexist in patients on maintenance hemodialysis (MHD). We aimed to determine the effects of systemic inflammation on skeletal muscle protein metabolism in MHD patients. METHODS Whole body and skeletal muscle protein turnover were assessed by stable isotope kinetic studies. We incorporated expressions of E1, E214K, E3αI, E3αII, MuRF-1, and atrogin-1 in skeletal muscle tissue from integrin β1 gene KO CKD mice models. RESULTS Among 129 patients with mean (± SD) age 47 ± 12 years, 74% were African American, 73% were male, and 22% had diabetes mellitus. Median high-sensitivity C-reactive protein (hs-CRP) concentration was 13 (interquartile range 0.8, 33) mg/l. There were statistically significant associations between hs-CRP and forearm skeletal muscle protein synthesis, degradation, and net forearm skeletal muscle protein balance (P < 0.001 for all). The associations remained statistically significant after adjustment for clinical and demographic confounders, as well as in sensitivity analysis, excluding patients with diabetes mellitus. In attempting to identify potential mechanisms involved in this correlation, we show increased expressions of E1, E214K, E3αI, E3αII, MuRF-1, and atrogin-1 in skeletal muscle tissue obtained from an animal model of chronic kidney disease. CONCLUSION These data suggest that systemic inflammation is a strong and independent determinant of skeletal muscle protein homeostasis in MHD patients, providing rationale for further studies using anticytokine therapies in patients with underlying systemic inflammation. FUNDING This study was in part supported by NIH grants R01 DK45604 and 1K24 DK62849, the Clinical Translational Science Award UL1-TR000445 from the National Center for Advancing Translational Sciences, the Veterans Administration Merit Award I01 CX000414, the SatelliteHealth Normon Coplon Extramural Grant Program, and the FDA grant 000943.
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Affiliation(s)
- Serpil M Deger
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.,CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease
| | - Adriana M Hung
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.,CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease
| | | | - Edward D Siew
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.,CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease
| | - Charles D Ellis
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease
| | - Cindy Booker
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.,CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease
| | - Feng Sha
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA
| | - Haiming Li
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, VUMC, Nashville, Tennessee, USA
| | | | - Roy Zent
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease
| | - William E Mitch
- Selzman Institute for Kidney Health, Baylor College of Medicine, Department of Medicine, Houston, Texas, USA
| | | | - T Alp Ikizler
- Division of Nephrology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA.,CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA.,Vanderbilt Center for Kidney Disease
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10
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Spoto B, Pisano A, Zoccali C. Insulin resistance in chronic kidney disease: a systematic review. Am J Physiol Renal Physiol 2016; 311:F1087-F1108. [DOI: 10.1152/ajprenal.00340.2016] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/28/2016] [Indexed: 01/07/2023] Open
Abstract
Insulin resistance (IR) is an early metabolic alteration in chronic kidney disease (CKD) patients, being apparent when the glomerular filtration rate is still within the normal range and becoming almost universal in those who reach the end stage of kidney failure. The skeletal muscle represents the primary site of IR in CKD, and alterations at sites beyond the insulin receptor are recognized as the main defect underlying IR in this condition. Estimates of IR based on fasting insulin concentration are easier and faster but may not be adequate in patients with CKD because renal insufficiency reduces insulin catabolism. The hyperinsulinemic euglycemic clamp is the gold standard for the assessment of insulin sensitivity because this technique allows a direct measure of skeletal muscle sensitivity to insulin. The etiology of IR in CKD is multifactorial in nature and may be secondary to disturbances that are prominent in renal diseases, including physical inactivity, chronic inflammation, oxidative stress, vitamin D deficiency, metabolic acidosis, anemia, adipokine derangement, and altered gut microbiome. IR contributes to the progression of renal disease by worsening renal hemodynamics by various mechanisms, including activation of the sympathetic nervous system, sodium retention, and downregulation of the natriuretic peptide system. IR has been solidly associated with intermediate mechanisms leading to cardiovascular (CV) disease in CKD including left ventricular hypertrophy, vascular dysfunction, and atherosclerosis. However, it remains unclear whether IR is an independent predictor of mortality and CV complications in CKD. Because IR is a modifiable risk factor and its reduction may lower CV morbidity and mortality, unveiling the molecular mechanisms responsible for the pathogenesis of CKD-related insulin resistance is of importance for the identification of novel therapeutic targets aimed at reducing the high CV risk of this condition.
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Affiliation(s)
- Belinda Spoto
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio di Calabria, Italy
| | - Anna Pisano
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio di Calabria, Italy
| | - Carmine Zoccali
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio di Calabria, Italy
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King-Morris KR, Deger SM, Hung AM, Egbert PA, Ellis CD, Graves A, Shintani A, Ikizler TA. Measurement and Correlation of Indices of Insulin Resistance in Patients on Peritoneal Dialysis. Perit Dial Int 2015; 36:433-41. [PMID: 26526047 DOI: 10.3747/pdi.2013.00296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/23/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Insulin resistance (IR) is common in maintenance dialysis patients and is associated with excess mortality. Hyperinsulinemic euglycemic glucose clamp (HEGC) is the gold standard for measuring IR. There are limited studies using HEGC for comparison to other indirect indices of IR in peritoneal dialysis (PD) patients, nor have there been direct comparisons between patients receiving PD and those on maintenance hemodialysis (MHD) with regard to severity of IR, methods of measurement, or factors associated with the development of IR. ♦ METHODS This is a cross-sectional, single-center study performed in 10 prevalent PD patients of median age 48 years (range 41 - 54); 50% were female and 60% were African American. Insulin resistance was assessed by HEGC (glucose disposal rate [GDR]), homeostatic model assessment of IR (HOMA-IR), HOMA-IR corrected by adiponectin (HOMA-AD), leptin adiponectin ratio (LAR), quantitative insulin sensitivity check index (QUICKI), McAuley's index, and oral glucose tolerance test (OGTT) at each time point for a total of 18 studies. Retrospective analysis compared this cohort to 12 hemodialysis patients who had previously undergone similar testing. ♦ RESULTS The median GDR was 6.4 mg/kg/min (interquartile range [IQR] 6.0, 7.8) in the PD cohort compared with the MHD group, which was 5.7 mg/kg/min (IQR 4.3, 6.6). For both the PD and MHD cohorts, the best predictors of GDR by HEGC after adjusting for age, gender, and body mass index (BMI), were HOMA-AD (PD: r = -0.69, p = 0.01; MHD: r = -0.78, p = 0.03) and LAR (PD: r = -0.68, p < 0.001; MHD: r = -0.65, p = 0.04). In both groups, HOMA-IR and QUICKI failed to have strong predictive value. Eight of 10 PD patients had at least 1 abnormal OGTT, demonstrating impaired glucose tolerance. ♦ CONCLUSIONS Insulin resistance is highly prevalent in PD patients. The adipokine based formulas, HOMA-AD and LAR, correlated well in both the PD and MHD populations in predicting GDR by HEGC, outperforming HOMA-IR. The use of these novel markers could be considered for large-scale, epidemiological outcome studies.
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Affiliation(s)
| | | | - Adriana M Hung
- Vanderbilt University Medical Center, Nashville, Tennessee, USA Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | | | - Charles D Ellis
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy Graves
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ayumi Shintani
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - T Alp Ikizler
- Vanderbilt University Medical Center, Nashville, Tennessee, USA Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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12
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Fragoso A, Mendes F, Silva AP, Neves PL. Insulin resistance as a predictor of cardiovascular morbidity and end-stage renal disease. J Diabetes Complications 2015; 29:1098-104. [PMID: 26066409 DOI: 10.1016/j.jdiacomp.2015.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/07/2015] [Accepted: 05/18/2015] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- André Fragoso
- Nephrology Department, Centro Hospitalar do Algarve, Faro, Portugal.
| | - Filipa Mendes
- Nephrology Department, Centro Hospitalar do Algarve, Faro, Portugal
| | - Ana Paula Silva
- Nephrology Department, Centro Hospitalar do Algarve, Faro, Portugal; Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Pedro Leão Neves
- Nephrology Department, Centro Hospitalar do Algarve, Faro, Portugal; Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
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Takenaka T, Inoue T, Watanabe Y. How the kidney hyperfiltrates in diabetes: From molecules to hemodynamics. World J Diabetes 2015; 6:576-582. [PMID: 25987955 PMCID: PMC4434078 DOI: 10.4239/wjd.v6.i4.576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/24/2014] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
In this review, we focused on two molecules, connexin and sodium-glucose cotransporter, which can link to diabetic hyperfiltration. In diabetic kidney, the activation of renin-angiotensin system occurs simultaneously with glomerular hyperfiltration. The latter largely depends on pathophysiological afferent arteriolar dilation in the presence of high angiotensin II. As a mechanistic basis for the above, tubular hypothesis has been proposed for type 1 diabetic patients as well as experimental models. Although tubular hypothesis has not been well evaluated in type 2 diabetes, clinical observations support that tubular hypothesis is true also in type 2 diabetes. Recent results on tubular hypothesis along with connexin abnormality in type 2 diabetes were revisited. In addition, the importance of sodium-glucose cotransporter in diabetic hyperfiltration is discussed. The link between salt paradox and the activation of renin-angiotensin system will be also reviewed.
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Bertinato J, Wu Xiao C, Ratnayake WMN, Fernandez L, Lavergne C, Wood C, Swist E. Lower serum magnesium concentration is associated with diabetes, insulin resistance, and obesity in South Asian and white Canadian women but not men. Food Nutr Res 2015; 59:25974. [PMID: 25947295 PMCID: PMC4422846 DOI: 10.3402/fnr.v59.25974] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 12/17/2022] Open
Abstract
Background A large proportion of adults in North America are not meeting recommended intakes for magnesium (Mg). Women and people of South Asian race may be at higher risk for Mg deficiency because of lower Mg intakes relative to requirements and increased susceptibility to diabetes, respectively. Objective This study compared serum Mg concentrations in South Asian (n=276) and white (n=315) Canadian women and men aged 20–79 years living in Canada's Capital Region and examined the relationship with diabetes, glucose control, insulin resistance, and body mass index. Results Serum Mg concentration was lower in women of both races and South Asians of both genders. Racial differences in serum Mg were not significant after controlling for use of diabetes medication. A substantial proportion of South Asian (18%) and white (9%) women had serum Mg <0.75 mmol/L indicating hypomagnesemia. Use of diabetes medication and indicators of poorer glucose control, insulin resistance, and obesity were associated with lower serum Mg in women, but not in men. Conclusions These results suggest that the higher incidence of diabetes in South Asians increases their risk for Mg deficiency and that health conditions that increase Mg requirements have a greater effect on Mg status in women than men.
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Affiliation(s)
- Jesse Bertinato
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada;
| | - Chao Wu Xiao
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - W M Nimal Ratnayake
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Canada
| | - Lois Fernandez
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Canada
| | - Christopher Lavergne
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Canada.,Department of Biology, University of Ottawa, Ottawa, Canada
| | - Carla Wood
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Canada
| | - Eleonora Swist
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Ottawa, Canada
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15
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Chen HY, Lin CC, Chiu YL, Hsu SP, Pai MF, Yang JY, Wu HY, Peng YS. Liver fat contents, abdominal adiposity and insulin resistance in non-diabetic prevalent hemodialysis patients. Blood Purif 2014; 38:55-61. [PMID: 25277327 DOI: 10.1159/000365136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/10/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The liver fat contents and abdominal adiposity correlate well with insulin resistance (IR) in the general population. However, the relationship between liver fat content, abdominal adiposity and IR in non-diabetic hemodialysis (HD) patients remains unclear. This study aimed to clarify the associations among these factors. METHODS This is a cross-sectional, observational study. All patients received abdominal ultrasound for liver fat content. Abdominal adiposity was quantified with the conicity index (Ci) and waist circumference (WC). We checked the homeostasis model assessment for insulin resistance index (HOMA-IR) for IR. RESULTS A total of 112 patients (60 women) were analyzed. Subjects with higher liver fat contents and WC had higher IR indices. But Ci did not correlate with IR indices. In both the multi-variable linear regression model and the logistic regression model, only higher liver fat content predicted a severe IR status. CONCLUSIONS Liver fat contents have a remarkable correlation with IR; however, abdominal adiposity, measured either by Ci or WC, dose not independently correlate with IR in non-diabetic prevalent HD patients.
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Affiliation(s)
- Hung-Yuan Chen
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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16
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Karakan S, Sezer S, Ozdemir Acar FN. Insulin resistance and left ventricular mass in non-diabetic hemodialysis patients. Curr Ther Res Clin Exp 2014; 73:165-73. [PMID: 24653518 DOI: 10.1016/j.curtheres.2012.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) is frequently recognized in patients with uremia, and it is thought that IR has a basic role in the pathogenesis of cardiovascular disease. OBJECTIVE To evaluate the effect of IR on cardiovascular risk in non-diabetic patients receiving hemodialysis (HD). METHODS We performed a cross-sectional observational study that comprised 186 non-diabetic patients receiving HD (95 men; mean [SD] age, 46.4 [10.8] years; age range, 35-60 years) who had been receiving HD for 7.3 (3.5) years. Demographic variables and laboratory values were recorded. Insulin resistance was determined using the Homeostatic Model Assessment (HOMA), and the left ventricular mass index (LVMI) was calculated via echocardiography. RESULTS According to HOMA-IR levels, patients were categorized as having IR (HOMA-IR score ≥2.5; n = 53) or not having IR (HOMA-IR score <2.5; n = 133). Insulin resistance was determined in 28.4% of study patients. Compared with the non-IR group, the IR group had been receiving HD longer; had greater body mass index; and had higher serum creatinine, uric acid, triglyceride, insulin, and C-reactive protein concentrations, leukocyte count, and LVMI (P < 0.05). Patients with increased LVMI had significantly higher body mass index, systolic blood pressure, serum cholesterol and C-reactive protein concentrations, and HOMA score. At multivariate analysis, systolic blood pressure (β = 0.22; P = 0.03) and HOMA score (β = 0.26; P = 0.01) affected LVMI. CONCLUSIONS Insulin resistance and hypertension are independent risk factors for left ventricular hypertrophy in non-diabetic patients with uremia who are receiving HD. Further studies are needed to indicate the benefits of improving IR for cardiovascular mortality in this subgroup of patients with uremia.
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Affiliation(s)
- Sebnem Karakan
- Department of Nephrology, Baskent University, Ankara, Turkey
| | - Siren Sezer
- Department of Nephrology, Baskent University, Ankara, Turkey
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Molsted S, Harrison AP, Eidemak I, Dela F, Andersen JL. Improved glucose tolerance after high-load strength training in patients undergoing dialysis. Nephron Clin Pract 2013; 123:134-41. [PMID: 23887226 DOI: 10.1159/000353231] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 05/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this controlled study was to investigate the effect of high-load strength training on glucose tolerance in patients undergoing dialysis. METHODS 23 patients treated by dialysis underwent a 16-week control period followed by 16 weeks of strength training three times a week. Muscle fiber size, composition and capillary density were analyzed in biopsies obtained in the vastus lateralis muscle. Glucose tolerance and the insulin response were measured by a 2-hour oral glucose tolerance test. RESULTS All outcome measures remained unchanged during the control period. After strength training the relative area of type 2X fibers was decreased. Muscle fiber size and capillary density remained unchanged. After the strength training, insulin concentrations were significantly lower in patients with impaired glucose tolerance or type 2 diabetes (n = 14) (fasting insulin from 68 ± 12 (46-96) to 54 ± 10 (37-77) pmol/l, p < 0.05, 2-hour insulin from 533 ± 104 (356-776) to 344 ± 68 (226-510) pmol/l, p < 0.05, total insulin area under the curve from 1,868 ± 334 (1,268-2,536) to 1,465 ± 222 (1,094-1,913), p < 0.05). Insulin concentrations were unchanged in patients with normal glucose tolerance (n = 9). CONCLUSION The conducted strength training was associated with a significant improvement in glucose tolerance in patients with impaired glucose tolerance or type 2 diabetes undergoing dialysis. The effect was apparently not associated with muscle hypertrophy, whereas the muscle fiber type composition was changed.
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Affiliation(s)
- Stig Molsted
- Department of Basic Animal and Veterinary Sciences, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
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18
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Koppe L, Pillon NJ, Vella RE, Croze ML, Pelletier CC, Chambert S, Massy Z, Glorieux G, Vanholder R, Dugenet Y, Soula HA, Fouque D, Soulage CO. p-Cresyl sulfate promotes insulin resistance associated with CKD. J Am Soc Nephrol 2013; 24:88-99. [PMID: 23274953 DOI: 10.1681/asn.2012050503] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The mechanisms underlying the insulin resistance that frequently accompanies CKD are poorly understood, but the retention of renally excreted compounds may play a role. One such compound is p-cresyl sulfate (PCS), a protein-bound uremic toxin that originates from tyrosine metabolism by intestinal microbes. Here, we sought to determine whether PCS contributes to CKD-associated insulin resistance. Administering PCS to mice with normal kidney function for 4 weeks triggered insulin resistance, loss of fat mass, and ectopic redistribution of lipid in muscle and liver, mimicking features associated with CKD. Mice treated with PCS exhibited altered insulin signaling in skeletal muscle through ERK1/2 activation. In addition, exposing C2C12 myotubes to concentrations of PCS observed in CKD caused insulin resistance through direct activation of ERK1/2. Subtotal nephrectomy led to insulin resistance and dyslipidemia in mice, and treatment with the prebiotic arabino-xylo-oligosaccharide, which reduced serum PCS by decreasing intestinal production of p-cresol, prevented these metabolic derangements. Taken together, these data suggest that PCS contributes to insulin resistance and that targeting PCS may be a therapeutic strategy in CKD.
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Affiliation(s)
- Laetitia Koppe
- Hospices Civils de Lyon, Department of Nephrology, Hôpital E Herriot, Lyon, France
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Semple DJ, Bhandari S, Seymour AML. Uremic cardiomyopathy is characterized by loss of the cardioprotective effects of insulin. Am J Physiol Renal Physiol 2012; 303:F1275-86. [DOI: 10.1152/ajprenal.00048.2012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease is associated with a unique cardiomyopathy, characterized by a combination of structural and cellular remodeling, and an enhanced susceptibility to ischemia-reperfusion injury. This may represent dysfunction of the reperfusion injury salvage kinase pathway due to insulin resistance. The susceptibility of the uremic heart to ischemia-reperfusion injury and the cardioprotective effects of insulin and rosiglitazone were investigated. Uremia was induced in Sprague-Dawley rats by subtotal nephrectomy. Functional recovery from ischemia was investigated in vitro in control and uremic hearts ± insulin ± rosiglitazone. The response of myocardial oxidative metabolism to insulin was determined by13C-NMR spectroscopy. Activation of reperfusion injury salvage kinase pathway intermediates (Akt and GSK3β) were assessed by SDS-PAGE and immunoprecipitation. Insulin improved postischemic rate pressure product in control but not uremic hearts, [recovered rate pressure product (%), control 59.6 ± 10.7 vs. 88.9 ± 8.5, P < 0.05; uremic 19.3 ± 4.6 vs. 28.5 ± 10.4, P = ns]. Rosiglitazone resensitized uremic hearts to insulin-mediated cardioprotection [recovered rate pressure product (%) 12.7 ± 7.0 vs. 61.8 ± 15.9, P < 0.05]. Myocardial carbohydrate metabolism remained responsive to insulin in uremic hearts. Uremia was associated with increased phosphorylation of Akt (1.00 ± 0.08 vs. 1.31 ± 0.11, P < 0.05) in normoxia, but no change in postischemic phosphorylation of Akt or GSK3β. Akt2 isoform expression was decreased postischemia in uremic hearts ( P < 0.05). Uremia is associated with enhanced susceptibility to ischemia-reperfusion injury and a loss of insulin-mediated cardioprotection, which can be restored by administration of rosiglitazone. Altered Akt2 expression in uremic hearts post-ischemia-reperfusion and impaired activation of the reperfusion injury salvage kinase pathway may underlie these findings.
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Affiliation(s)
- David J. Semple
- Department of Biological Sciences and Hull York Medical School, University of Hull, Kingston-upon-Hull, United Kingdom; and
| | - Sunil Bhandari
- Department of Renal Medicine, Hull and East Yorkshire Hospital NHS Trust, and Hull York Medical School, Kingston-upon-Hull, United Kingdom
| | - Anne-Marie L. Seymour
- Department of Biological Sciences and Hull York Medical School, University of Hull, Kingston-upon-Hull, United Kingdom; and
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Takenaka T, Nobe K, Okayama M, Kojima E, Nodaira Y, Sueyoshi K, Hoshi H, Watanabe Y, Takane H, Suzuki H. Aliskiren reduces morning blood pressure in hypertensive patients with diabetic nephropathy. Clin Exp Hypertens 2012; 34:243-8. [PMID: 22559034 DOI: 10.3109/10641963.2012.681080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetic nephropathy (DN) is a leading disease that requires renal replacement therapy. The progression of renal dysfunction in DN is faster than the other renal diseases. While antihypertensive therapy reduces albuminuria, a good indicator for the progression, hypertension in DN is treatment resistant. Among patients with DN who took angiotensin receptor blockers (ARBs), 27 patients who exhibited poor control of albuminuria were enrolled into the study. Angiotensin receptor blocker was exchanged to aliskiren (150-300 mg/d) and clinical parameters were followed for 6 months. Exchange to aliskiren decreased albuminuria (1.57 ± 0.68 to 0.89 ± 0.45 g/gCr, P < .01) without changes in estimated glomerular filtration rate and office blood pressure (BP). Body weight and hemoglobin A1c were not altered. Aliskiren also reduced plasma renin activity (2.0 ± 0.9 to 1.2 ± 0.6 ng/mL/h, P < .01). While evening BP was unchanged, morning systolic BP (139 ± 8 to 132 ± 7 mm Hg, P < .01) and diastolic BP (81 ± 7 to 76 ± 6 mm Hg, P < .05) were decreased significantly after 6 months. Our results indicated that aliskiren decreased BP, especially morning BP in hypertensive patients with DN. The present data suggest that aliskiren exerts renoprotective actions including reduction in albumin excretion for patients with DN.
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Affiliation(s)
- Tsuneo Takenaka
- Department of Nephrology, Saitama Medical University, Iruma, Saitama, Japan.
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Hung AM, Sundell MB, Egbert P, Siew ED, Shintani A, Ellis CD, Bian A, Ikizler TA. A comparison of novel and commonly-used indices of insulin sensitivity in African American chronic hemodialysis patients. Clin J Am Soc Nephrol 2011; 6:767-74. [PMID: 21441124 DOI: 10.2215/cjn.08070910] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Insulin resistance (IR) is highly prevalent in chronic hemodialysis (CHD) patients and is associated with poor cardiovascular outcomes. Hyperinsulinemic euglycemic glucose clamp (HEGC) is the gold standard for measuring IR. The comparison of commonly-used indirect indices of IR to HEGC has not been adequately performed in this population. Furthermore, the validity of newly proposed adipokine-based IR indices has not been explored. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This is an observational study performed in a single center, involving 12 prevalent CHD patients (50 ± 9 years old, 100% African American, 33% women, body mass index of 34.4 ± 7.6 kg/m(2)) who were studied three consecutive times. IR was assessed by HEGC (glucose-disposal rate [GDR]), homeostatic model assessment of IR (HOMA-IR), HOMA-IR corrected by adiponectin (HOMA-AD), leptin adiponectin ratio (LAR), QUICKI, and the McAuley's index at each time point. RESULTS Eighty-three percent of the subjects displayed either glucose intolerance or overt insulin resistance by HEGC (GDR median, 5.71; interquartile range [IQR], 4.16, 6.81). LAR and HOMA-AD were the best correlates of IR measured by HEGC (r=-0.72, P<0.001, and -0.67, P<0.001), respectively. Fat percentage, interleukin-6, and adipokines (leptin, adiponectin, and resistin) were strongly associated with GDR. HEGC, LAR, and HOMA-AD had the best intraclass correlation coefficients. CONCLUSION IR is common in CHD patients. Adipokine-based indices are the best correlates of IR measurements by HEGC. HOMA-IR and QUICKI are reasonable alternatives. Use of these indices may allow better detection of alterations in insulin sensitivity in CHD patients.
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Affiliation(s)
- Adriana M Hung
- Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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Takenaka T, Sato T, Hoshi H, Kato N, Sueyoshi K, Tsuda M, Watanabe Y, Takane H, Ohno Y, Suzuki H. Height constitutes an important predictor of mortality in end-stage renal disease. Cardiol Res Pract 2010; 2011:242353. [PMID: 21113297 PMCID: PMC2989382 DOI: 10.4061/2011/242353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 09/20/2010] [Accepted: 10/02/2010] [Indexed: 12/23/2022] Open
Abstract
Aim. Height is an important determinant of augmentation index (AI) that anticipates cardiovascular prognosis. There is a scanty of the data whether short height predicts survival in patients with end-stage renal diseases, a high risk population. Methods. Fifty two hypertensive patients with type 2 diabetic nephropathy receiving hemodialysis and 52 patients with nondiabetic nephropathy were enrolled. In addition to AI estimated with radial artery tonometry, classical cardiovascular risk factors were considered. Patients were followed for 2 years to assess cardiovascular prognosis. Results. Cox hazards regression revealed that both smoking and shortness in height independently contributed to total mortality and indicated that smoking as well as the presence of left ventricular hypertrophy predicted cardiovascular mortality. Our findings implicated that high AI, the presence of diabetes, and low high-density lipoprotein cholesterol were significant contributors to cardiovascular events. Conclusions. Our findings provide new evidence that shortness in height independently contributes to total mortality in hemodialysis patients.
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Affiliation(s)
- Tsuneo Takenaka
- Department of Medicine, Saitama Medical College, 38 Moro-hongo, Moroyama, Iruma, Saitama 395-0495, Japan
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Semple D, Smith K, Bhandari S, Seymour AML. Uremic cardiomyopathy and insulin resistance: a critical role for akt? J Am Soc Nephrol 2010; 22:207-15. [PMID: 20634295 DOI: 10.1681/asn.2009090900] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Uremic cardiomyopathy is a classic complication of chronic renal failure whose cause is unclear and treatment remains disappointing. Insulin resistance is an independent predictor of cardiovascular mortality in chronic renal failure. Underlying insulin resistance are defects in insulin signaling through the protein kinase, Akt. Akt acts as a nodal point in the control of both the metabolic and pleiotropic effects of insulin. Imbalance among these effects leads to cardiac hypertrophy, fibrosis, and apoptosis; less angiogenesis; metabolic remodeling; and altered calcium cycling, all key features of uremic cardiomyopathy. Here we consider the role of Akt in the development of uremic cardiomyopathy, drawing parallels from models of hypertrophic cardiac disease.
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Affiliation(s)
- David Semple
- Department of Biological Sciences, University of Hull, Kingston-upon-Hull, HU6 7RX, UK
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Tahara N, Yamagishi SI, Matsui T, Takeuchi M, Nitta Y, Kodama N, Mizoguchi M, Imaizumi T. Serum Levels of Advanced Glycation End Products (AGEs) are Independent Correlates of Insulin Resistance in Nondiabetic Subjects. Cardiovasc Ther 2010; 30:42-8. [DOI: 10.1111/j.1755-5922.2010.00177.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Guebre-Egziabher F, Kalbacher E, Fouque D. [Insulin resistance and inflammation in chronic kidney diseases]. Nephrol Ther 2010; 5 Suppl 5:S346-52. [PMID: 19761971 DOI: 10.1016/s1769-7255(09)75168-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Insulin resistance (IR) and inflammation are now identified as common features in chronic kidney disease (CKD) patients. These metabolic abnormalities are both predictors of adverse cardiovascular (CV) outcome and are associated with worst nutritional status. Unequivocal experimental, epidemiological and clinical evidence produced during the past decade causally links inflammation to the development of metabolic syndrome or the complications that emerge from these pathologies particularly in the context of obesity or type II diabetes patients. These observations lead to the hypothesis of "meta-inflammation" : metabolically triggered inflammation, with a key role played by adipose tissue. In CKD patients, many other factors related with uremia can be causative but the abnormal cytokine and adipokine concentrations and the cluster of metabolic abnormalities push us to think like other metabolic diseases, that adipose tissue dysfunction may be among the pathways that induce inflammation and IR. Therapeutic approaches of traditional CV risk factors have been inconclusive or failed to improve the outcome of these patients. Further studies assessing the impact of renal failure on adipose tissue function and the pathways that are altered in this disease may allow to have therapeutic approaches targetting adipose tissue dysfunction or inflammation.
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Stegmayr B, Olivecrona T, Olivecrona G. Lipoprotein lipase disturbances induced by uremia and hemodialysis. Semin Dial 2010; 22:442-4. [PMID: 19708998 DOI: 10.1111/j.1525-139x.2009.00597.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Factors such as malnutrition, physical inactivity, uremic toxins, and inflammation are known to influence the activity of lipoprotein lipase (LPL), an important enzyme in metabolism of blood lipids. In patients with chronic kidney disease these factors are common and may result in a decreased LPL activity. This is particularly so in patients on hemodialysis. Further, during each dialysis treatment, the use of heparin (or low molecular weight heparin) induces a release of LPL from its normal binding sites at the plasma membrane of endothelial cells. This results in an increased degradation of the enzyme and a relative lack of LPL activity for up to 10 hours from the start of the dialysis. Thus, the use of conventional anticoagulation for hemodialysis, in addition to the consequences of the uremic state, may cause a severe functional deficiency of LPL. This in turn may have deleterious effects on energy metabolism and may contribute to the increased risk for cardiovascular disease in this vulnerable group of patients.
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Affiliation(s)
- Bernd Stegmayr
- Department of Internal Medicine, Division of Nephrology, University Hospital, Umeå, Sweeden.
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D'Apolito M, Du X, Zong H, Catucci A, Maiuri L, Trivisano T, Pettoello-Mantovani M, Campanozzi A, Raia V, Pessin JE, Brownlee M, Giardino I. Urea-induced ROS generation causes insulin resistance in mice with chronic renal failure. J Clin Invest 2009; 120:203-13. [PMID: 19955654 DOI: 10.1172/jci37672] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 10/07/2009] [Indexed: 12/30/2022] Open
Abstract
Although supraphysiological concentrations of urea are known to increase oxidative stress in cultured cells, it is generally thought that the elevated levels of urea in chronic renal failure patients have negligible toxicity. We previously demonstrated that ROS increase intracellular protein modification by O-linked beta-N-acetylglucosamine (O-GlcNAc), and others showed that increased modification of insulin signaling molecules by O-GlcNAc reduces insulin signal transduction. Because both oxidative stress and insulin resistance have been observed in patients with end-stage renal disease, we sought to determine the role of urea in these phenotypes. Treatment of 3T3-L1 adipocytes with urea at disease-relevant concentrations induced ROS production, caused insulin resistance, increased expression of adipokines retinol binding protein 4 (RBP4) and resistin, and increased O-GlcNAc-modified insulin signaling molecules. Investigation of a mouse model of surgically induced renal failure (uremic mice) revealed increased ROS production, modification of insulin signaling molecules by O-GlcNAc, and increased expression of RBP4 and resistin in visceral adipose tissue. Uremic mice also displayed insulin resistance and glucose intolerance, and treatment with an antioxidant SOD/catalase mimetic normalized these defects. The SOD/catalase mimetic treatment also prevented the development of insulin resistance in normal mice after urea infusion. These data suggest that therapeutic targeting of urea-induced ROS may help reduce the high morbidity and mortality caused by end-stage renal disease.
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Affiliation(s)
- Maria D'Apolito
- Institute of Pediatrics, University of Foggia, Viale Pinto 1 O.O.R.R., Foggia, Italy
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Niepolski L, Grzegorzewska AE, Młot-Michalska M. Visfatin and endogenous secretory receptor for advanced glycation end-products in diabetic type 2 and non-diabetic patients undergoing intermittent hemodialysis. Int Urol Nephrol 2009; 42:441-52. [DOI: 10.1007/s11255-009-9525-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/06/2009] [Indexed: 01/25/2023]
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Takenaka T, Hoshi H, Kato N, Kobayashi K, Takane H, Shoda J, Suzuki H. Cardio-ankle vascular index to screen cardiovascular diseases in patients with end-stage renal diseases. J Atheroscler Thromb 2008; 15:339-44. [PMID: 19060424 DOI: 10.5551/jat.e584] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cardiovascular diseases constitute major causes of death in patients with chronic kidney diseases. An increase in arterial stiffness predicts the presence of cardiovascular diseases; however, non-invasive arterial stiffness parameters such as pulse wave velocity are confounded by blood pressure. METHODS A new arterial stiffness parameter beta for the arterial tree, cardio-ankle vascular index (CAVI), was measured. To examine the usefulness of CAVI to screen for the presence of cardiovascular diseases, cross-sectional studies were performed on 68 patients undergoing chronic hemodialysis. RESULTS Stepwise regression analysis indicated that CAVI significantly correlated to age (beta=0.05, p<0.01) but not blood pressure. In addition, CAVI was higher in diabetics than non-diabetics (8.39+/-0.37 vs 7.63+/-0.57, p<0.05). Furthermore, CAVI was markedly elevated in patients with a history of cardiovascular diseases (8.69+/-0.23 vs 6.66+/-0.28, p<0.01). Analysis using the ROC curve has demonstrated that CAVI of 7.55 constitutes the cut-off value for the presence of cardiovascular diseases with both sensitivity and specificity of 0.79. CONCLUSION The present findings suggest that CAVI can be used as a screening test to detect for the presence of cardiovascular diseases in patients undergoing hemodialysis.
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Affiliation(s)
- Tsuneo Takenaka
- Department of Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
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Sakkas GK, Karatzaferi C, Zintzaras E, Giannaki CD, Liakopoulos V, Lavdas E, Damani E, Liakos N, Fezoulidis I, Koutedakis Y, Stefanidis I. Liver fat, visceral adiposity, and sleep disturbances contribute to the development of insulin resistance and glucose intolerance in nondiabetic dialysis patients. Am J Physiol Regul Integr Comp Physiol 2008; 295:R1721-9. [DOI: 10.1152/ajpregu.00935.2007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hemodialysis patients exhibit insulin resistance (IR) in target organs such as liver, muscles, and adipose tissue. The aim of this study was to identify contributors to IR and to develop a model for predicting glucose intolerance in nondiabetic hemodialysis patients. After a 2-h, 75-g oral glucose tolerance test (OGTT), 34 hemodialysis patients were divided into groups with normal (NGT) and impaired glucose tolerance (IGT). Indices of insulin sensitivity were derived from OGTT data. Measurements included liver and muscle fat infiltration and central adiposity by computed tomography scans, body composition by dual energy X-ray absorptiometer, sleep quality by full polysomnography, and functional capacity and quality of life (QoL) by a battery of exercise tests and questionnaires. Cut-off points, as well as sensitivity and specificity calculations were based on IR (insulin sensitivity index by Matsuda) using a receiver operator characteristics (ROC) curve analysis. Fifteen patients were assigned to the IGT, and 19 subjects to the NGT group. Intrahepatic fat content and visceral adiposity were significantly higher in the IGT group. IR indices strongly correlated with sleep disturbances, visceral adiposity, functional capacity, and QoL. Visceral adiposity, O2 desaturation during sleep, intrahepatic fat content, and QoL score fitted into the model for predicting glucose intolerance. A ROC curve analysis identified an intrahepatic fat content of >3.97% (sensitivity, 100; specificity, 35.7) as the best cutoff point for predicting IR. Visceral and intrahepatic fat content, as well as QoL and sleep seemed to be involved at some point in the development of glucose intolerance in hemodialysis patients. Means of reducing fat depots in the liver and splachnic area might prove promising in combating IR and cardiovascular risk in hemodialysis patients.
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