A Comparison of Novel and Commonly-Used Indices of Insulin Sensitivity in African American Chronic Hemodialysis Patients

Hung, Adriana M.; Sundell, Mary B.; Egbert, Phyllis; Siew, Edward D.; Shintani, Ayumi; Ellis, Charles D.; Bian, Aihua; İkizler, T. Alp

doi:10.2215/cjn.08070910

Cited by 62 publications

(74 citation statements)

References 37 publications

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“…However, this method is expensive and not suitable for use in clinical practice. HOMA-IR, however, is easy to perform and validated as a valuable alternative of insulin sensitivity both in non-CKD patients (11,35), in CKD patients stages III and IV (36,37), and in HD patients (10).…”

Section: Discussionmentioning

confidence: 99%

“…Hung et al (10) have shown that leptin/adiponectin ratio (LAR) and homeostasis model assessment corrected for adiponectin (HOMA-AD) were the better correlates of glucose-disposal rate measured by hyperinsulinemic euglycemic glucose clamp in chronic HD patients. LAR has been recently proposed as a new atherogenic index, since it has been associated with cardiovascular events in PD (6).…”

Section: Introductionmentioning

confidence: 99%

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Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Bernardo

Oliveira

Santos³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Insulin resistance has been associated with cardiovascular disease in peritoneal dialysis patients. Few studies have addressed the impact of fast transport status or dialysis prescription on insulin resistance. The aim of this study was to test whether insulin resistance is associated with obesity parameters, peritoneal transport rate, and glucose absorption.Design, setting, participants, & measurements Insulin resistance was evaluated with homeostasis model assessment method (HOMA-IR), additionally corrected by adiponectin (HOMA-AD). Enrolled patients were prevalent nondiabetics attending at Santo António Hospital Peritoneal Dialysis Unit, who were free of hospitalization or infectious events in the previous 3 months (51 patients aged 50.4615.9 years, 59% women). Leptin, adiponectin, insulin-like growth factor-binding protein 1 (IGFBP-1), and daily glucose absorption were also measured. Lean tissue index, fat tissue index (FTI), and relative fat mass (rel.FM) were assessed using multifrequency bioimpedance. Patients were categorized according to dialysate to plasma creatinine ratio at 4 hours, 3.86% peritoneal equilibration test, and obesity parameters.Results Obesity was present in 49% of patients according to rel.FM. HOMA-IR correlated better with FTI than with body mass index. Significant correlations were found in obese, but not in nonobese patients, between HOMA-IR and leptin, leptin/adiponectin ratio (LAR), and IGFBP-1. HOMA-IR correlated with HOMA-AD, but did not correlate with glucose absorption or transport rate. There were no significant differences in insulin resistance indices, glucose absorption, and body composition parameters between fast and nonfast transporters. A total of 18 patients (35.3%) who had insulin resistance presented with higher LAR and rel. FM (7.3 [12.3, interquartile range] versus 0.7 [1.4, interquartile range], P,0.001, and 39.4610.1% versus 27.2611.5%, P=0.002, respectively), lower IGFBP-1 (8.267.2 versus 21.0616.3 ng/ml, P=0.002), but similar glucose absorption and small-solute transport compared with patients without insulin resistance. FTI and LAR were independent correlates of HOMA-IR in multivariate analysis adjusted for glucose absorption and small-solute transport (r=0.82, P,0.001).Conclusions Insulin resistance in nondiabetic peritoneal dialysis patients is associated with obesity and LAR independent of glucose absorption and small-solute transport status. Fast transport status was not associated with higher likelihood of obesity or insulin resistance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Bernardo

Oliveira

Santos³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…The mean of M/I was 5.162.2 1003mg/kg per minute per 1 mU/L insulin. As many as 24.0% of the subjects were considered insulin-resistant (M,4.0 mg/kg per minute), 63.5% of the subjects were considered insulinintolerant (M=4.0-7.5 mg/kg per minute), and only 12.5% of the subjects were considered insulin-sensitive (M.7.5 mg/kg per minute) (20). Clinical and biochemical characteristics of included subjects are shown in Table 1 stratified by quartiles of M distribution.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Clinical Correlates of Insulin Sensitivity and Its Association with Mortality among Men with CKD Stages 3 and 4

Huang

Ärnlöv

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Insulin resistance participates in the pathogenesis of multiple metabolic and cardiovascular diseases. CKD patients have impaired insulin sensitivity, but the clinical correlates and outcome associations of impaired insulin sensitivity in this vulnerable population are not well defined.Design, setting, participants, & measurements The prospective cohort study was from the third examination cycle of the Uppsala Longitudinal Study of Adult Men, a population-based survey of elderly men ages 70-71 years; insulin sensitivity was assessed by glucose disposal rate as measured with euglycemic clamps. Inclusion criterion was eGFR,60 ml/min per 1.73 m 2 (n=543). Exclusion criteria were incomplete data on euglycemic clamp and diabetes (n=97), leaving 446 men with CKD stages 3 and 4 (eGFR median=51.9 ml/min per 1.73 m 2 ; range=20.2-59.5 ml/min per 1.73 m 2 ).Results The mean of glucose disposal rate was 5.461.9 mg/kg per minute. In multivariable analysis, the independent clinical correlates of glucose disposal rate were eGFR (slope, 0.02; 95% confidence interval, 0.01 to 0.04), hypertension (20.48; 95% confidence interval, 20.86 to 20.11), hyperlipidemia (20.51; 95% confidence interval, 20.84 to 20.18), and body mass index (20.32; 95% confidence interval, 20.37 to 20.27). During follow-up (median=10.0 years; interquartile range=8.7-11.0 years), 149 participants died. In Cox regression models, glucose disposal rate was not associated with all-cause or cardiovascular mortality. Multiplicative interactions (P,0.05) were observed between glucose disposal rate and physical activity or smoking in total mortality association. After subsequent stratification, glucose disposal rate was an independent correlate of all-cause mortality in smokers (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.96 per 1 mg/kg per minute glucose disposal rate increase) and physically inactive individuals (hazard ratio, 0.77; 95% confidence interval, 0.61 to 0.97) but not their counterparts.Conclusion eGFR, together with various components of the metabolic syndrome, contributed to explain the variance of insulin sensitivity in men with CKD stages 3 and 4. Insulin sensitivity was associated with a lower mortality risk in individuals who smoked and individuals who were physically inactive.

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“…2010 (8). Glucose concentrations were measured by using the glucose oxidase method and insulin by double-antibody RIA, (Glucose Analyzer 2; Beckman Coulter, Brea, CA, and DA RIA; Millipore, St. Charles, MO, respectively).…”

Section: Methodsmentioning

confidence: 99%

Measurement and Correlation of Indices of Insulin Resistance in Patients on Peritoneal Dialysis

et al. 2016

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Background Insulin resistance (IR) is common in maintenance dialysis patients and is associated with excess mortality. Hyperinsulinemic euglycemic glucose clamp (HEGC) is the gold standard for measuring IR. There are limited studies using HEGC for comparison to other indirect indices of IR in peritoneal dialysis (PD) patients, nor have there been direct comparisons between patients receiving PD and those on maintenance hemodialysis (MHD) with regard to severity of IR, methods of measurement, or factors associated with the development of IR. Methods This is a cross-sectional, single center study performed in 10 prevalent PD patients of median age 48 years (range 41 – 54); 50% were female and 60% were African American. Insulin resistance was assessed by HEGC (glucose disposal rate [GDR]), homeostatic model assessment of IR (HOMA-IR), HOMA-IR corrected by adiponectin (HOMA-AD), leptin adiponectin ratio (LAR), QUICKI, McAuley’s index, and Oral Glucose Tolerance Test (OGTT) at each time point for a total of 18 studies. Retrospective analysis compared this cohort to 12 hemodialysis patients who had previously undergone similar testing. Results The median GDR was 6.4 mg/kg/min (interquartile range [IQR] 6.0, 7.8) in the PD cohort compared with the MHD group, which was 5.7 mg/kg/min (IQR 4.3, 6.6). For both the PD and MHD cohorts, the best predictors of GDR by HEGC after adjusting for age, gender, and body mass index (BMI), were HOMA-AD (PD: r = −0.69, p = 0.01; MHD: r = −0.78, p = 0.03) and LAR (PD: r = −0.68, p < 0.001; MHD: r = −0.65, p = 0.04). In both groups, HOMA-IR and QUICKI failed to have strong predictive value. Eight of 10 PD patients had at least 1 abnormal OGTT, demonstrating impaired glucose tolerance. Conclusions Insulin resistance is highly prevalent in PD patients. The adipokine based formulas, HOMA-AD and LAR, correlated well in both the PD and MHD populations in predicting GDR by HEGC, outperforming HOMA-IR. The use of these novel markers could be considered for large-scale, epidemiological outcome studies.

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A Comparison of Novel and Commonly-Used Indices of Insulin Sensitivity in African American Chronic Hemodialysis Patients

Cited by 62 publications

References 37 publications

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Clinical Correlates of Insulin Sensitivity and Its Association with Mortality among Men with CKD Stages 3 and 4

Measurement and Correlation of Indices of Insulin Resistance in Patients on Peritoneal Dialysis

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