Study of markers of atherosclerosis including insulin resistance in patients with chronic renal failure

M. V. Chandrakanth, Sidhartha Das, Shashi Bhusan Rout, Rina Mohanty, Sharat Chandra Singh, Madhusmita Pattnaik, Bibuthi Sethy

Department of Nephrology, Sriram Chandra Bhanj Medical College, Cuttack, India.
Postgraduate Department of Medicine, Sriram Chandra Bhanj Medical College, Cuttack, India.

DOI: 10.4236/jdm.2012.22033                

Abstract

Objectives: The present study was designed to assess the markers of atherosclerosis including Insulin resistance (IR) in na?ve patients with chronic renal failure (CRF). Methods: Eighty consecutive na?ve patients with CRF were taken up for study. They were divided into non-diabetic group, Group A (N = 50) and diabetic group, Group B (N = 30). Twenty healthy individuals were taken as controls, Group C (N = 20). Patients undergoing renal replacement therapy, having chronic liver disease and with concomitant acute or chronic infection were excluded from the study. Routine hemogram, fasting plasma glucose, fasting serum insulin ,lipid profile, renal function tests, C-reactive protein (CRP), serum uric acid levels, ultrasound of abdomen and ultrasound B scan for carotid intima medial thickness (CIMT) were done for all patients and control. The data collected were analyzed to inter-correlate the parameters using SPSS 16. Results: On comparing parameters between the three groups, values of HOMA-IR, CRP, uric acid, VLDL and CIMT were significantly higher in Groups A and B than Group C whereas values of HOMA-B, HDL and LDL were lower in both groups A and Bas compared to group C. HOMA-IR had significant negative correlation with creatinine clearance (Crcl) (r = -0.449, p = 0.01) in Group A and (r = -0.483, p = 0.007) in Group B. HOMA-IR had significant positive correlation with CIMT (r = 0.413, p = 0.03) in Group A and (r = 0.581, p = 0.001) in Group B. Crcl had significant negative correlation with CIMT(r = -0.375, p = 0.007) in Group A and (r = -0.705, p = 0.001) in Group B. Crclnegatively correlated with C-reactive protein (r = -0.460, p = 0.001) in Group A and (r = 0.431, p = 0.01) in Group B. HOMA-B positively correlated with Crcl (r = 0.667, p = 0.001) and also with CIMT (r = -0.531, p = 0.003) among Group B individuals. Conclusion: There is a significant increase in insulin resistance (IR) and β cell dysfunction in patients with CRF. Also IR linearly increases with reduction in renal function. CRP and uric acid are also significantly increased, reflecting the existence of a chronic inflammatory milieu in these patients. All these factors contribute to accelerated atherosclerosis, signifying CRF per se is independent risk factor for atherosclerosis.

Keywords

CKD; CRF; CrCl; Atherosclerosis; HOMA-IR; HOMA-B; CRP; CIMT

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bargman, J.M. and Skorecki, K. (2011) Chronic kidney disease. In: Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J. and Loscalzo, J., Eds., Harrison’s Principles of Internal Medicine, 18th Edition, McGraw Hill, New York, 2308-2321.
[2]	McMahon, L.P. and Parfrey, P.S. (2008) Cardiovascular aspects of chronic kidney disease. In: Brenner, B.M. and Rector, F.C., Eds., The Kidney, 8th Edition, Saunders, Philadelphia, 1697-1727.
[3]	Ritz, E., Adamczack, M. and Wiecek, A. Metabolic and Endocrine Dysfunctions in Uremia. In: Schrier, R.W., Ed., Diseases of the Kidney and Urinary Tract, 8th Edition, Lippincott Williams & Wilkins, Philadelphia, 96, 2502-2538.
[4]	Fadda, G.Z. and Massry, S.G. (1995) Glucose and insulin metabolism. Metabolism and endocrine disturbances in uremia. In: Massry, S.G. and Glassock, R.J., Eds., Massry and Glassok’s Textbook of Clinical Nephrology, Lippincott Williams & Wilkins, Philadelphia, 1390-1394.
[5]	Matthews, D.R., Hosker, J.B., Rudenski, A.S., Naylor, B.A., Treacher, D.F. and Turner, R.C. (1985) Homeostasis model assessment: Insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 28, 412-419. doi:10.1007/BF00280883
[6]	Chen, J., Muntner, P., Hamm, L.L., Fonseca, V., Batuman, V., Whelton, P.K. and He, J. (2003) Insulin resistance and risk of chronic kidney disease in nondiabetic US adults. Journal of the American Society of Nephrology, 14, 469-477. doi:10.1097/01.ASN.0000046029.53933.09
[7]	Kobayashi, S., Maesato, K., Moriya, H., Ohtake, T. and Ikeda, T. (2005) Insulin resistance in patients with chronic kidney disease. American Journal of Kidney Disease, 45, 275-280. doi:10.1053/j.ajkd.2004.09.034
[8]	Cases, A. and Coll, E. (2005) Dyslipidemia and the progression of renal disease in chronic renal failure patients. Kidney International, 68, 87-93. doi:10.1111/j.1523-1755.2005.09916.x
[9]	Menon, V. (2005) The epidemiology of chronic kidney disease, stages 1 to 4 and cardiovascular disease: A high risk combination. American Journal of Kidney Diease, 45, 223-232. doi:10.1053/j.ajkd.2004.09.022
[10]	Madero, M., Sarnak, M.J., Wang, X.L., Greene, T., Beck, G.J., Kusek, J.W., Collins, A.J., Levey, A.S. and Menon, V. (2009) Uric acid and long-term outcomes in CKD. American Journal of Kidney Disease, 2009; 53, 796-803. doi:10.1053/j.ajkd.2008.12.021
[11]	Szeto, C.-C., Chow, K.-M., Woo, K.-S., Chook, P., Kwan, B.C.H., Leung, C.-B. and Li, P.K.T. (2007) Carotid intima media thickness predicts cardiovascular diseases in Chinese predialysis patients with chronic kidney disease. Journal of the American Society of Nephrology, 18, 1966-1972
[12]	Fox, E.R., Benjamin, E.J., Sarpong, D.F., Nagarajarao, H., Taylor, J.K., Steffes, M.W. and Salahudeen, A.K. (2010) The relation of C-reactive protein to chronic kidney disease in African Americans: The Jackson heart study. BMC Nephrology, 11.
[13]	Das, S., Dash, G.K., Behera, M., Routray, S.N., Minz, N.T. and Pattnaik, M. (2007) Prevalence of metabolic syndrome in angiographically established coronary artery disease patients. South Asian Journal of Preventive Cardiology, 11, 93-100.