Glucose and Insulin Metabolism in Uremia

Mak, Robert H.; DeFronzo, Ralph A.

doi:10.1159/000186953

Cited by 211 publications

(133 citation statements)

References 31 publications

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“…It is widely known that hypertension and hyperlipidemia play important roles in the progression of renal disease [17] and that insulin resistance may be involved in the pathogenesis of hypertension [18]. Moreover, nutritional, metabolic, and cardiovascular complications of renal disease may be consequences of abnormal insulin action [19]. Therefore, long-standing renal dysfunction may cause atherosclerosis prior to the initiation of dialysis therapy.…”

Section: Insulin Resistance and Ckdmentioning

confidence: 99%

Cardiovascular events in chronic kidney disease (CKD)—an importance of vascular calcification and microcirculatory impairment

Kobayashi

2016

Ren Replace Ther

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In patients with chronic kidney disease (CKD), particularly in patients with hemodialysis, cardiovascular mortality rate is extremely high. Polyvascular diseases develop at an early stage of CKD. Pathophysiology includes insulin resistance and/or imbalance between nitric oxide (NO) and endothelin bioavailability as well as oxidative stress. Overlooked pathophysiology may be hemorheological disarrangement because of hyperfibrinogenemia, and higher rate of production for monocyte-platelet complexes in circulation, which plays an important role for atherosclerosis. In terms of clinical findings, most of nephrologists have already known about the importance of coronary artery disease, while few of nephrologists are aware of devastating influence of peripheral arterial disease (PAD) on prognosis for the patients with CKD which is known to be one of the independent risk factors for PAD. The understanding in pathophysiology of vascular calcification and strategic treatment is a critical issue to achieve favorable outcome for the patients with CKD. In this regard, FGF-23 and associated factors together with Klotho molecules play an important role. In this article, we aim to review the cardiovascular disease for the patients with CKD with a particular emphasis on the clinical aspects of polyvascular disease. Finally, we address to detect microcirculatory impairment and eradicate vascular calcification as early as possible prior to renal replacement therapy. Apparently, FGF-23-Klotho gene axis as well as vitamin D and phosphate control should be investigated vigorously.

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Section: Insulin Resistance and Ckdmentioning

confidence: 99%

Cardiovascular events in chronic kidney disease (CKD)—an importance of vascular calcification and microcirculatory impairment

Kobayashi

2016

Ren Replace Ther

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“…Hence the dose of insulin should be halved once glomerular filtration rate (GFR) is less than 10 mL/min [21]. Although a consensus approach is lacking but most authorities endorse using rapid acting insulin like lispro before each meal alongside close monitoring of blood glucose [17].…”

Section: Insulin Remains Cornerstone Of Treatmentmentioning

confidence: 99%

Management of Diabetes in Patients on Hemodialysis

Qayyum¹

2016

UNOAJ

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“…Impaired tissue sensitivity to insulin occurs in almost all uremic subjects and is largely responsible for the abnormal glucose metabolism seen in this setting (Mak & DeFronzo, 1992). Both experimental and clinical studies suggest that hepatic glucose production and uptake are normal in uremia and that skeletal muscle is the primary site of insulin resistance (Androgue, 1992).…”

Section: Insulin Metabolismmentioning

confidence: 99%