Abstract
Background
Metabolic syndrome (MetS) has been found to be associated with an increased risk for chronic kidney disease (CKD). However, the relationship between insulin resistance (IR), which is believed to play a central role in the pathogenesis of MetS, and CKD is still unclear in Chinese adults and needs further investigation.
Methods
This 3-year follow-up study included 3237 middle-aged and elderly Chinese without CKD at baseline. Estimated glomerular filtration rate (eGFR) 60–90 mL/min/1.73 m2 was defined as the mildly reduced eGFR; CKD was defined as eGFR < 60 mL/min/1.73 m2. MetS was defined based on the China guideline for type 2 diabetes. IR was measured by the homeostatic model assessment of IR (HOMA-IR). Incidences of mildly reduced eGFR and CKD from normal eGFR were calculated. The roles of MetS and IR in predicting the progression of CKD were estimated using multiple logistic regression models.
Results
The incidences of CKD and mildly reduced eGFR for the entire cohort were 20.08 and 33.28 per 1000 person-years, respectively. A large proportion [13.1% (182/1394)] of patients with mildly reduced eGFR progressed to CKD in 3 years. After accounting for age, gender, five components of MetS and HOMA-IR in multiple logistic regression model, only IR presented increased OR (1.119, 95% CI 1.052–1.189, p < 0.001) for CKD. When we included MetS instead of its five components in model, both MetS (OR 1.420, 95% CI 1.020–1.977, p = 0.038) and HOMA-IR (OR 1.118, 95% CI 1.055–1.186, p < 0.001) showed increased risk for CKD progression.
Conclusions
Both IR and MetS accelerate the progression of CKD among Chinese adults. Single metabolic abnormality did not have enough potency to induce the occurrence of CKD in 3 years.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, Chen M, He Q, Liao Y, Yu X, Chen N, Zhang JE, Hu Z, Liu F, Hong D, Ma L, Liu H, Zhou X, Chen J, Pan L, Chen W, Li X, Wang H (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822
White SL, Cass A, Atkins RC, Chadban SJ (2005) Chronic kidney disease in the general population. Adv Chronic Kidney Dis 12(1):5–13
Chen J, Kong X, Jia X, Li W, Wang Z, Cui M, Xu D (2017) Association between metabolic syndrome and chronic kidney disease in a Chinese urban population. Clin Chim Acta 470:103–108
Luk AO, So WY, Ma RC, Kong AP, Ozaki R, Ng VS, Yu LW, Lau WW, Yang X, Chow FC, Chan JC, Tong PC (2008) Metabolic syndrome predicts new onset of chronic kidney disease in 5,829 patients with type 2 diabetes: a 5-year prospective analysis of the Hong Kong Diabetes Registry. Diabetes Care 31(12):2357–2361
Hayashi K, Takayama M, Abe T, Kanda T, Hirose H, Shimizu-Hirota R, Shiomi E, Iwao Y, Itoh H (2017) Investigation of metabolic factors associated with eGFR decline over 1 year in a Japanese population without CKD. J Atheroscler Thromb 24(8):863–875
Park JH, Oh SW, Ahn SY, Kim S, Na KY, Chae DW, Chin HJ (2013) Decreased estimated glomerular filtration rate is not directly related to increased insulin resistance. Diabetes Res Clin Pract 99(3):366–371
Jang CM, Hyun YY, Lee KB, Kim H (2015) Insulin resistance is associated with the development of albuminuria in Korean subjects without diabetes. Endocrine 48(1):203–210
Chen S, Chen Y, Liu X, Li M, Wu B, Li Y, Liang Y, Shao X, Holthofer H, Zou H (2013) Association of insulin resistance with chronic kidney disease in non-diabetic subjects with normal weight. PLoS ONE 8(9):e74058
Jing C, Xu S, Ming J, Cai J, Zhang R, Shen H, Yang W, Ji Q (2015) Insulin resistance is not independently associated with chronic kidney disease in Chinese population: a population-based cross-sectional study. Clin Chim Acta 448:232–237
Spoto B, Pisano A, Zoccali C (2016) Insulin resistance in chronic kidney disease: a systematic review. Am J Physiol Renal Physiol 311(6):F1087–F1108
Teta D (2015) Insulin resistance as a therapeutic target for chronic kidney disease. J Ren Nutr 25(2):226–229
Ning G (2012) Risk evaluation of cAncers in Chinese diabeTic individuals: a lONgitudinal (REACTION) study. J Diabetes 4(2):172–173
Ning G, Bloomgarden Z (2015) Diabetes and cancer: findings from the REACTION studyREACTION. J Diabetes 7(2):143–144
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612
National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(2 Suppl 1):S1–S266
Society CD (2014) China guideline for type 2 diabetes. Chin J Diabetes Mellit 6(7):447–498
Mathew RO, Bangalore S, Lavelle MP, Pellikka PA, Sidhu MS, Boden WE, Asif A (2017) Diagnosis and management of atherosclerotic cardiovascular disease in chronic kidney disease: a review. Kidney Int 91(4):797–807
Roy SK, Cespedes A, Li D, Choi TY, Budoff MJ (2011) Mild and moderate pre-dialysis chronic kidney disease is associated with increased coronary artery calcium. Vasc Health Risk Manag 7:719–724
Natali A, Boldrini B, Baldi S, Rossi M, Landi P, Severi S, Solini A, Ferrannini E (2014) Impact of mild to moderate reductions of glomerular filtration rate on coronary artery disease severity. Nutr Metab Cardiovasc Dis 24(6):681–688
Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, Whelton PK, He J (2004) The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med 140(3):167–174
Wang C, Liang K, Zhang X, Li C, Yang W, Ma Z, Sun Y, Song J, Lin P, Gong L, Wang M, Liu F, Li W, Xiao J, Yan F, Yang J, Wang L, Tian M, Liu J, Zhao R, Hou X, Chen L (2014) Metabolic abnormalities, but not obesity, contribute to the mildly reduced eGFR in middle-aged and elderly Chinese. Int Urol Nephrol 46(9):1793–1799
Fliser D, Pacini G, Engelleiter R, Kautzky-Willer A, Prager R, Franek E, Ritz E (1998) Insulin resistance and hyperinsulinemia are already present in patients with incipient renal disease. Kidney Int 53(5):1343–1347
DeFronzo RA, Alvestrand A, Smith D, Hendler R, Hendler E, Wahren J (1981) Insulin resistance in uremia. J Clin Invest 67(2):563–568
Liao MT, Sung CC, Hung KC, Wu CC, Lo L, Lu KC (2012) Insulin resistance in patients with chronic kidney disease. J Biomed Biotechnol. https://doi.org/10.1155/2012/691369
de Boer IH, Mehrotra R (2014) Insulin resistance in chronic kidney disease: a step closer to effective evaluation and treatment. Kidney Int 86(2):243–245
Jessani S, Levey AS, Bux R, Inker LA, Islam M, Chaturvedi N, Mariat C, Schmid CH, Jafar TH (2014) Estimation of GFR in South Asians: a study from the general population in Pakistan. Am J Kidney Dis 63(1):49–58
Acknowledgements
This study was supported by the National Natural Science Foundation of China (Nos. 81700739, 81670706) and the National Health and Family Planning Commission Foundation (No. 201502007). We would like to thank LetPub (http://www.letpub.com) for providing linguistic assistance during the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Confiict of interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Ma, A., Liu, F., Wang, C. et al. Both insulin resistance and metabolic syndrome accelerate the progression of chronic kidney disease among Chinese adults: results from a 3-year follow-up study. Int Urol Nephrol 50, 2239–2244 (2018). https://doi.org/10.1007/s11255-018-1934-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-018-1934-6