The prevalence of insulin resistance in nondiabetic nonobese patients with chronic kidney disease

This study was undertaken to evaluate the prevalence of insulin resistance (IR) and associated factors in nondiabetic, nonobese patients with chronic kidney disease (CKD) who had not yet received dialysis therapy. A group of 89 consecutive patients (42 male, 47 female) who were hospitalized in the Nephrology Clinic at Dicle University, had recently been diagnosed with CKD, and had not yet been treated with dialysis were enrolled in the study, as was a control group of 30 healthy volunteers. Diabetic and obese patients were excluded. IR was determined by the homeostasis model assessment of IR (HOMA-IR) formula. Blood samples were taken after an overnight fasting period to establish serum glucose, insulin, C-peptide, albumin, lipid profile, hematocrit, bicarbonate, and intact parathormone (iPTH) levels. The mean age of patients was 48.7+/-19.7 y (men, 49.5+/-21.5 y; women, 48.1+/-18.0 y); other mean values were as follows: glucose, 98.4+/-20.6 mg/dL; insulin, 16.7+/-16.2 microU/mL; HOMA-IR, 5.46+/-1.14; hemoglobin (Hgb), 8.7+/-1.6 g/dL; calcium-phosphorus product (Ca x P), 52.2+/-16.2 mg2/dL2; iPTH, 377.7+/-258.1 pg/mL, and bicarbonate (HCO3), 16.6+/-5.3 mEq/L. HOMA-IR was significantly higher in patients with stage 4 CKD than in controls (P.001); serum levels of urea, creatinine clearance (CrCl), C-reactive protein (CRP), albumin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), Hgb, HCO3, Ca x P, and iPTH were found to be associated with HOMA-IR when a comparison was made with the control group. According to correlation analyses of possible risk factors in patients with IR, positive correlations with age, body mass index, CRP, Ca x P product, and iPTH, and negative correlations with albumin, CrCl, Hgb, and HDL-C were found. A high percentage of IR was found, and this percentage increased as glomerular filtration rate decreased in patients with stage 4 CKD. In addition, a correlation was found between IR and parameters such as age, body mass index, CRP, Ca x P, iPTH, albumin, CrCl, Hgb, and HDL-C.