Evidence to Support a Putative Role for Insulin Resistance in Chronic Kidney Disease

Abstract

Introduction: The primary cause of morbidity and mortality in the renal patient is a cardiovascular event. Insulin resistance (IR) contributes to this event by increasing cardiovascular disease (CVD) and accelerating rates of decline in kidney function. Here we review the historical background of IR in patients with chronic kidney disease (CKD) and present evidence for a role of IR in accelerating cardiovascular and renal diseases.
Review: The high prevalence of IR in CKD patients is well documented. It is suggested that increased IR in the renal patient is caused by uremia as well as by other known factors in the general population. Patients with CKD have an alarmingly high risk for cardiovascular morbidity and mortality. There is overwhelming evidence to support a role for IR in increased CVD morbidity and mortality in the general population, which is likely to extend to CKD patients. Some of the traditional treatment measures for IR, such as metformin, may not be applicable to the renal patient. Other options include weight reduction, exercise, treatment of anemia to improve exercise tolerance, treatment of vitamin D deficiency, thiazolidinediones, and dialysis. IR is estimated by studying the relationship between blood glucose and the concomitant insulin level. Such measurement may help identify patients at increased risk for future cardiovascular events and guide treatment measures.
Conclusion: Sufficient evidence supports the increased prevalence of IR in kidney patients. Treating IR may retard the progression of CKD and decrease the incidence of cardiovascular events in this high risk population.

Keywords: chronic kidney diseass, cardiovascular disease, insulin resistance