Insulin resistance in chronic kidney disease
Bachmakov I.E., Fedoseev A.N., Denisova V.E.
1) Academy of Postgraduate Education under the FSBU “Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency”, Moscow, Russia;
2) City Clinical Hospital №24 Department of Health of the City of Moscow, Moscow, Russia
This review provides an overview of insulin resistance (IR) in patients with chronic kidney disease (CKD).
Insulin resistance is often associated with CKD even independent of presence of obesity or diabetes mellitus and may be both a consequence of renal impairment and accelerate development of kidney disorders.
Factors playing a role in development of insulin resistance in CKD patients include both lifestyle characteristics (e.g., physical inactivity, unhealthy diet) and chronic renal dysfunction (e.g., metabolic acidosis, vitamin D deficiency, renal anemia, and uremic toxins), while obesity and diabetes mellitus may additionally exacerbate decline in insulin sensitivity.
There is extensive evidence showing that chronic systemic inflammation, oxidative stress, dysregulation of adipokines secretion, and activation of renin-angiotensin-aldosterone system (RAAS) are involved in mechanisms of IR development in patients with CKD.
In research and clinical practice, dynamic (e.g., oral glucose tolerance test based on changes in blood glucose and insulin concentrations in response to standard oral glucose load) and static (e.g., HOMA-IR insulin resistance index utilizing fasting glucose and insulin concentrations) IR models are widely used for assessment of insulin sensitivity in CKD due to their sufficient accuracy, practicability, and low cost.
Since IR is associated with both the risk of cardiovascular morbidity and mortality and accelerated development of cardiovascular and renal complications in patients with CKD, it is important to take effective measures for the prevention and treatment of this condition as early as possible, including lifestyle modification, targeted pharmacotherapy, and - in the terminal stage kidney disease - renal replacement therapy.
About the Autors
Iouri E. Bachmakov – MD., PhD., Lecturer at the Department of Internal Medicine, Academy of Postgraduate Education, Federal Scientific Clinical Center of specialized medical care and medical technology FMBA of Russia, Moscow. Address: 91 Volokolamskoye Shosse, Moscow, 125371; e-mail: email@example.com.
Anatoly N Fedoseev - Dr.Sci. (Med.), Professor at the Department of Internal Medicine, Academy of Postgraduate Education, Federal Scientific Clinical Center of specialized medical care and medical technology FMBA of Russia, Moscow. Address: 91 Volokolamskoye Shosse, Moscow, 125371; tel.: +7(495)617-10-50; e-mail: firstname.lastname@example.org. Viktoria E. Denisova – Nephrologist, City Clinical Hospital № 24 of the Moscow Healthcare Department, Moscow; Address: 10 Pistsovaya st., Moscow, 127015. e-mail: gkb24@ zdrav.mos.ru