a Nephrology Unit, Internal Medicine Department, School of Medicine , Cairo University , Cairo , Egypt.
b Internal Medicine Department, School of Medicine , Cairo University , Cairo , Egypt.
Ren Fail. 2018 Nov;40(1):226-230. doi: 10.1080/0886022X.2018.1455594.
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 ± 12.3 pg/mL, p < .001), PTH (76.9 ± 15.27 vs. 47.9 ± 2.52 pg/mL, p < .001), P (4.3 ± 0.67 vs. 3.6 ± 0.23 mg/dL, p < .001), and UA (5 ± 1.22 vs. 4.85 ± 0.48 mg/dL, p < .001) and significantly lower Ca (8.2 ± 0.3 vs. 8.9 ± 0.33 mg/dL, p < .001), and 25 (OH) vit D (17 ± 5.63 vs. 37 ± 3.43 ng/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.
胰岛素抵抗（IR）在慢性肾脏病（CKD）患者中非常常见。矿物质和骨代谢紊乱（MBD）似乎在胰岛素抵抗的发病机制中起作用。成纤维细胞生长因子 23（FGF23）作为 MBD 和 CKD 许多病理序列之间最重要的联系正在发展。目的是在接受透析前的 CKD 患者中评估胰岛素抵抗（IR），以寻找 MBD 与 CKD 患者之间的可能关联。选择了 100 名 3-5 期 CKD 患者，以及 20 名正常对照组。使用稳态模型评估胰岛素抵抗（HOMA-IR）来评估所选病例中的 IR。比较两组的空腹血糖（FBG）、空腹胰岛素（FBI）、HOMA-IR、估计肾小球滤过率（eGFR）、血清钙（Ca）、磷（P）、25 羟维生素 D（25（OH）vit D）、甲状旁腺激素（PTH）和尿酸（UA）。进行了 HOMA_IR 与不同研究参数之间的相关性研究。与对照组相比，CKD 患者的 HOMA-IR 显著更高（分别为 8.87±3.48 对 3.97±0.34，p<0.001）。此外，CKD 患者的 FGF23（235±22.96 对 139±12.3 pg/mL，p<0.001）、PTH（76.9±15.27 对 47.9±2.52 pg/mL，p<0.001）、P（4.3±0.67 对 3.6±0.23 mg/dL，p<0.001）和 UA（5±1.22 对 4.85±0.48 mg/dL，p<0.001）显著更高，而 Ca（8.2±0.3 对 8.9±0.33 mg/dL，p<0.001）和 25（OH）vit D（17±5.63 对 37±3.43 ng/mL，p<0.001）显著更低。逐步线性回归分析显示，BMI、GFR、Ca、P 和 FGF23 是 HOMA-IR 的唯一显著预测因子。CKD 中的胰岛素抵抗增加是尿毒症状态的结果，与磷酸盐代谢紊乱和 FGF23 密切相关。需要进一步研究以寻找潜在的机制。
