Relevance of Insulin Resistance in Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a major prevalent disease worldwide associated with low grade systemic inflammation, which predisposes to higher incidence of atherosclerotic complications in CKD. The study is intended to measure Insulin Resistance (IR) in chronic kidney disease and to decipher if there is any relation between IR and various stages of CKD.

The study population included 45 CKD and 45 healthy controls of either gender. Fasting Blood Sugar (FBS) and Serum Creatinine were measured in the fasting sample collected from both the groups. Estimated Glomerular Filtration Rate (eGFR) was calculated using MDRD formula. The fasting Insulin levels were estimated by Enzyme Linked Immuno Sorbant Assay (ELISA) method and IR was calculated by Homeostasis Model Assessment-Insulin resistance (HOMA IR) index. Regression analysis was used to find out the relationship between IR and other variables.

There was a significant increase in fasting insulin levels and IR in CKD cases (4.09±0.83) as compared to controls (0.8±0.2) [p<0.001], with no significant alteration in blood sugar level. A negative correlation was found between IR and eGFR in stage IV of CKD (r =-0.55, p<0.05) but was only statistically significant. Mutivariate regression analysis showed a significant relationship (R² =0.56) of IR with eGFR, creatinine, FBS.

In the present study there was hyper insulinemia associated with high HOMA-IR index but fasting blood sugar was not deranged. The study indicates causes for IR are multifactorial and greater degree of insulin resistance will predispose to worsening of renal function.