Pham Hong Tham, Truong-Nguyen Kim-Huong, Tran Minh-Hoang
Faculty of Pharmacy, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.
Department of Pharmacy, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam.
BMC Nephrol. 2025 Feb 7;26(1):62. doi: 10.1186/s12882-025-04005-6.
Future investigations on the association between insulin resistance in people without diabetes and chronic kidney disease (CKD) should consider the following aspects to facilitate causal inference and provide more robust findings. The study design should have an adequate follow-up period to rule out reverse causation and pre-existing diabetes, as well as to confirm the diagnosis of CKD. Known causes of CKD and relevant covariates should be identified where possible. Homeostasis model assessment of insulin resistance (HOMA-IR), being an indirect measure of insulin resistance, has limited sensitivity and specificity compared to direct methods like the hyperinsulinaemic-euglycaemic clamp. Regression modelling with HOMA-IR quartiles instead of continuous form may have masked more nuanced relationships. Sensitivity analyses, such as spline regression, could provide more insights about the association and mechanism. Propensity score methods could help address the inadequate overlap in covariate distributions, if present, by ensuring covariate balance. When investigating the CKD diagnostic performance of HOMA-IR, its cut-off for clinically meaningful insulin resistance should be well justified or comprehensively explored to improve the reliability of the results.
未来关于无糖尿病个体的胰岛素抵抗与慢性肾脏病（CKD）之间关联的研究应考虑以下方面，以促进因果推断并提供更可靠的结果。研究设计应具有足够的随访期，以排除反向因果关系和既往存在的糖尿病，以及确认CKD的诊断。应尽可能确定CKD的已知病因和相关协变量。胰岛素抵抗的稳态模型评估（HOMA-IR）作为胰岛素抵抗的间接测量方法，与高胰岛素-正葡萄糖钳夹等直接方法相比，敏感性和特异性有限。使用HOMA-IR四分位数而非连续形式进行回归建模可能掩盖了更细微的关系。敏感性分析，如样条回归，可提供有关关联和机制的更多见解。倾向得分方法可通过确保协变量平衡来帮助解决协变量分布中重叠不足的问题（如果存在）。在研究HOMA-IR对CKD的诊断性能时，其具有临床意义的胰岛素抵抗切点应有充分的理由或进行全面探索，以提高结果的可靠性。
