期刊
RENAL FAILURE
卷 40, 期 1, 页码 226-230出版社
TAYLOR & FRANCIS LTD
DOI: 10.1080/0886022X.2018.1455594
关键词
FGF23; CKD-MBD; insulin resistance; HOMA-IR; vitamin D; 25 OH vitamin D
Insulin resistance (IR) is very common among chronic kidney disease (CKD) patients. Disturbance in mineral and bone metabolism (MBD) seems to play a role in the pathogenesis of insulin resistance. Fibroblast growth factor-23 (FGF23) is evolving as the most important link between MBD and many pathologic sequences of CKD. The aim was to evaluate IR in pre-dialysis CKD patients looking for a possible association to mineral metabolism among CKD patients. A total of 100 stage 3-5 CKD patients were selected beside 20 normal control subjects. Homeostatic model assessment of insulin resistance (HOMA-IR) was used to assess IR in selected cases. Both groups were compared for fasting blood glucose (FBG), fasting blood insulin (FBI), HOMA-IR, estimated glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), 25 hydroxy vitamin D (25 OH vit D), parathormone (PTH), and uric acid (UA). Correlation study between HOMA_IR and different studied parameters was performed. HOMA-IR is significantly higher in CKD (8.87 +/- 3.48 vs. 3.97 +/- 0.34 in CKD vs. control, respectively, p<.001). In addition CKD patients have significantly higher FGF23 (235 +/- 22.96 vs. 139 +/- 12.3pg/mL, p<.001), PTH (76.9 +/- 15.27 vs. 47.9 +/- 2.52pg/mL, p<.001), P (4.3 +/- 0.67 vs. 3.6 +/- 0.23mg/dL, p<.001), and UA (5 +/- 1.22 vs. 4.85 +/- 0.48mg/dL, p<.001) and significantly lower Ca (8.2 +/- 0.3 vs. 8.9 +/- 0.33mg/dL, p<.001), and 25 (OH) vit D (17 +/- 5.63 vs. 37 +/- 3.43ng/mL, p<.001). Stepwise linear regression analysis revealed that BMI, GFR, Ca, P, and FGF23 were the only significant predictors of HOMA IR. Increased IR in CKD is a consequence of the uremic status and is intimately associated with disturbed phosphate metabolism and FGF23. Further studies are needed to look for an underlying mechanism.
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