Susceptibility to hyperglycemia in patients with chronic kidney disease

Am J Nephrol. 2009;29(5):406-13. doi: 10.1159/000171379. Epub 2008 Nov 7.

Abstract

Background: Patients with chronic kidney disease (CKD) are susceptible to hyperglycemia.

Aim: To study the prevalence of pre-diabetes in CKD patients and determine the contribution of insulin resistance (IR) versus beta-cell dysfunction in patients with CKD.

Methods: 45 consecutive nondiabetic CKD patients and 40 healthy subjects were included. Patients were divided into a normoglycemic (NG) and a pre-diabetic (PDM) group. IR was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function was assessed by proinsulin/insulin ratio and beta-cell%.

Results: The prevalence of PDM was 40%. The prevalence of high HOMA-IR was 22.2 and 77.8% in the NG and PDM groups. Compared to NG patients, the PDM group showed higher fasting plasma glucose, HOMA-IR, insulin, and proinsulin, while the prevalence of beta-cell dysfunction of 22.2% was lower than the 37% present in the NG group.

Conclusion: Increased IR, rather than beta-cell dysfunction, is the primary mechanism of PDM in CKD patients.

MeSH terms

  • Adiponectin / blood
  • Adult
  • Case-Control Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hyperglycemia / epidemiology
  • Hyperglycemia / etiology*
  • Insulin Resistance*
  • Insulin-Secreting Cells / physiology*
  • Male
  • Middle Aged
  • Prevalence
  • Reactive Oxygen Species / metabolism
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / epidemiology
  • Saskatchewan / epidemiology

Substances

  • Adiponectin
  • Reactive Oxygen Species