Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Nephrology Division, Department of Medicine, Michael E. Debakey VA Medical Center, Houston, Texas, USA.
Compr Physiol. 2023 Sep 28;13(4):5069-5076. doi: 10.1002/cphy.c220019.
Insulin regulates energy metabolism involving multiple organ systems. Insulin resistance (IR) occurs when organs exhibit reduced insulin sensitivity, leading to difficulties in maintaining glucose homeostasis. IR ensures decades prior to development of overt diabetes and can cause silent metabolic derangements. IR is typically seen very early in the course of chronic kidney disease (CKD) and is evident even when the estimated glomerular filtration rate (eGFR) is within the normal range and IR persists at various stages of kidney disease. In this article, we will discuss insulin handling by the kidneys, mechanisms responsible for IR in CKD, measurements and management of IR in patients with CKD, and recent type 2 diabetic trials with implications for improved cardiovascular outcomes in CKD. © 2023 American Physiological Society. Compr Physiol 13:5069-5076, 2023.
胰岛素调节涉及多个器官系统的能量代谢。当器官表现出胰岛素敏感性降低时，就会发生胰岛素抵抗（IR），导致葡萄糖稳态维持困难。IR 发生在明显糖尿病之前数十年，可以引起无声的代谢紊乱。IR 在慢性肾脏病（CKD）的早期阶段就很常见，即使估计的肾小球滤过率（eGFR）在正常范围内，并且在肾脏疾病的各个阶段仍然存在 IR。在本文中，我们将讨论肾脏对胰岛素的处理、CKD 中 IR 的发生机制、CKD 患者 IR 的测量和管理，以及最近的 2 型糖尿病试验及其对改善 CKD 患者心血管结局的影响。© 2023 美国生理学会。综合生理学 13:5069-5076, 2023.
