Fasting insulin level and Homatest IR as predictors of acute kidney injury in critically ill patients

Abstract

Background: Kidney dysfunction is a major cause of morbidity and mortality whose prevalence, mainly because of population ageing, is rising worldwide. Also the epidemics of abnormalities clustering with insulin resistance might have played a role in increasing the prevalence of kidney dysfunction. Insulin resistance has been associated with increased risk of cardiovascular events and mortality in multiple large community-based cohort studies. Objective: The aim of the study is to prove that insulin resistance not only may have a role in the development of chronic kidney disease but also may have a role in acute kidney injury. Methods: This was a case-control study. The cases of the study were taken from the medical intensive care unit (ICU) of the Faculty of Medicine Cairo University, 100 control patients stratified by age and gender and 219 critically ill ICU patients with AKI. Results: In the current study, we find that there is statistically significant higher fasting insulin levels and higher levels Homa IR in patients with AKI than patients without AKI. These results signify that patients with AKI had insulin resistance. In our study, the Homa IR showed non-significant correlation with APACHE and SOFA score. While fasting insulin level shows significant correlation only with SOFA score after 96 h. Conclusion: Our present observations indicate that patients with acute kidney injury have statistically significant higher insulin resistance.

Quantifying the Homeostatic Model Assessment of Insulin Resistance to Predict Mortality in Multi-organ Dysfunction Syndrome

“… 12 , 13 Though the current data are limited to mean HOMA-IR scores in critically ill patients, it signifies an association between the higher HOMA-IR values and the acute kidney injury/mortality. 9 , 14 Khan S et al measured a mean HOMA-IR score of 2.41 in euglycemic septic shock patients while measuring a value of 5.20 for hyperglycemic patients. 9 In MODS patients, Das et al obtained a mean HOMA-IR value of 5.14 vs 7.16 while Gupta et al obtained a mean HOMA-IR value of 0.9 vs 2.24 among survivors vs nonsurvivors, respectively.…”

Insulin Resistance and Homeostatic Model Assessment in Critically Ill: Where do We Stand?

“…Statistically significant higher fasting insulin levels and higher levels of HOMA-IR were observed in patients with AKI than patients without AKI. 14 However, in these studies with a subset of patients with acute pancreatitis and AKI, HOMA-IR is affected as disease per se has a significant effect on glucose/insulin homeostasis.…”